DENT  AL    CARIES 


ITS    CAUSES. 


INVESTIGATION   INTO   THE   INFLUENCE   OF   FUNGI 
IN  THE   DESTRUCTION   OF   THE  TEETH. 


DRS.  LEBER  AND  ROTTENSTEIN. 


TRANSLATED    BY 

THOMAS    H.    CHANDLER,    D.  M.  D., 

PROFESSOR  OF  MECHANICAL  DENTISTRY  IN   THE  DENTAL  SCHOOL  OF  HARVARD  UNIVERSITY. 


WITH    ILLUSTRATIONS. 


PHILADELPHIA: 
LINDSAY    &    BLAKISTON. 

18  73. 


Entered  according  to  Act  of  Congress,  in  the  year  1873, 

By  LINDSAY  &  BLAKISTOX, 

In  the  Office  of  the  Librarian  of  Congress,  at  Washington,  D.  C. 


SHERMAy  d-  CO.,  PRINTERS, 
PHILADELPHIA. 


TEANSLATOR'S  PREFACE. 


Having  accidentally  met  with  Leber  and  Rottenstein's  Recherches 
sur  la  Carie  Dentaire,  I  was  so  struck  with  its  views  upon  a  cursory 
examination  that  I  was  induced  to  give  it  a  more  careful  perusal, 
and  finally  to  translate  it,  that  others  might  have  the  benefit  of  them. 

Since  the  publication  of  Dr.  Bowditch's  investigations,  some  thirty 
years  ago,  vague  ideas  of  "Animaculse"  in  the  mouth,  and  of  their 
influence  upon  the  teeth,  particularly  in  the  formation  of  tartar,  have 
prevailed,  not  only  among  dentists^  but  their  patients.  There  have 
also  come  to  us  across  the  water  rumors  and  indefinite  statements  of 
discoveries  of  Fungi  in  diseased  matter  of  all  kinds,  and,  ou  the 
principle  "omne  ignotum  pro  mirifico,"  these  statements  have  been 
adopted  without  investigation,,  and  the  invisible  world  has  seemed 
to  be  coming  at  once  to  the  front,  and  claiming  a  much  larger  share 
of  our  life  and  welfare  than  the  visible. 

Fungi  have  also  been  described  in  the  teeth,  but,  until  the  publi- 
cation of  the  present  treatise,  nobody  has  seemed  to  put  his  finger 
upon  a  fungus,  and  point  out  its  work  in  any  specific  way.  The 
authors  have  stated  their  points  clearly,,  and  have  given  their  methods, 
so  that  those  who  desire  can  easily  follow  in  their  tracks  either  to 
verify  or  confute.  Meanwhile  I  have  thought  it  worth  my  while  to 
enlarge  their  audience  by  putting  their  work  into  an  English  dress, 


IV  TRANSLATOR    s    PREFACE. 

for  which  purpose  I  have  used  much  of  my  little  leisure  of  the  year 
past. 

Hoping  it  may  stimulate  to  investigation,  and  either  by  the  con- 
firmation or  disproval  of  its  statements  advance  the  knowledge  of 
the  whole  subject,  I  dedicate  the  result  of  my  labors  to  the  dental 
profession. 

The  Translator. 

January,  1873. 


AUTHORS'  PREFACE. 


We  began  our  inquiries  into  Dental  Caries  nearly  two  years  ago, 
and  continued  them  up  to  about  the  middle  of  last  year.  The  pub- 
lications uj^on  the  same  subject  which  have  appeared  in  the  interval 
have  not  discouraged  us.  The  study  of  the  histologic  changes 
undergone  by  the  dental  tissues  attacked  by  caries  had  led  us  to 
new  results,  and  appeared  to  have  furnished  us  with  important 
details  which  had  escaped  the  attention  of  other  observers. 

We  hope,  in  publishing  the  result  of  our  investigations,  to  throw 
some  light  upon  the  much-disputed  subject,  the  nature  of  Dental 
Caries. 

Our  work  is  not  a  monograph.  The  limits  we  have  assigned  to  it 
are  much  more  modest.  We  shall  confine  ourselves  to  stating  the 
results  of  our  observations,  giving  upon  the  progress,  the  symptoms, 
and  the  consequences  of  caries,  only  the  details  indispensable  to  the 
exposition  of  our  subject,  and  shall  conclude  with  some  very  brief 
therapeutic  deductions. 

In  view  of  the  great  diversity  of  opinion  among  authors  upon  the 
nature  of  Dental  Caries,  it  has  seemed  useful  to  preface  our  work  by 
a  review  of  the  investigations  made  and  theories  held  upon  this 
question  up  to  the  present  time. 


VI  AUTHORS     PREFACE. 

If  we  succeed  in  making  the  nature  of  Dental  Caries  better 
understood,  we  shall  have  attained  that  end  of  our  labors  which 
alone  we  had  proposed  to  ourselves. 

The  Authors. 

March  25th,  1868. 


CONTENTS. 


PAOE 

Tra2TSlator's  Preface,    ........  3 

Authors'  Preface, 5 

i.  résumé  of  the  inquiries  made,  up  to  the  present 

Day,  INTO  THE  Nature  of  Dental  Caries,    .  9 

II.  Anatomical   Alterations   of    the    Teeth   during 

Caries,      .........  17 

Central  Caries, .        .        .17 

Caries  of  the  Enamel,       .......  19 

Histologic  Changes  in  Caries  of  the  Enamel,  ...  21 

Leptothrix  Buccalis, 23 

Caries  of  the  Dentine,       .         .         .         .         .         .         .33 

Microscopic  Changes  of  the  Dentine  in  a  Carious  State,  39 

III.  Considerations  upon  the  Progress  and  Symptoms 

OF  Caries  of  the  Teeth, 59 

Stationary  Caries,     ........  74 

IV.  Causes  of  Caries, 80 

Predisposing  Causes  of  Caries  due  to  the  Form  and 

Structure  of  the  Teeth,     ^ 69 

Influence  of  Acids  upon  the  Production  of  Caries  of  the 

Teeth, 74 

Influence  of  Leptothrix  upon  the  Production  of  Caries  of 

the  Teeth, 96 

Therapeutic  Conclusions, 98 

Explanation  of  Plates,          101 


INQUIRIES 


DENTAL  CARIES. 


RESUME   OF  THE, INQUIRIES  MADE,    UP   TO    THE 

PRESENT  DAY,  INTO  THE  NATURE  OF 

DENTAL  CARIES. 

Under  the  name  of  Dental  Caries  is  comprehended  a  path- 
ologic process  which,  after  having  more  or  less  softened  and 
destroyed  the  tissues,  occasions  a  loss  of  substance,  and  ends, 
after  the  destruction  of  the  pulp,  in  the  entire  loss  of  the 
dental  organ.  This  process  has  nothing  in  common  with 
caries  of  the  bones  but  the  name.  It  diliers  from  it  entirely 
in  its  nature.  Nevertheless,  the  name  of  caries  has  come 
into  so  common  use  that  it  would  be  difficult  to  replace  it 
by  another,  and  as  for  the  rest,  no  one  will  ever  confound 
dental  caries  with  the  attection  of  the  bones  which  passes 
by  the  same  name. 

The  nature  of  dental  caries  has  for  ages  been  the  subject 
of  investigation.  The  ancient  physicians,  the  dentists  of 
their  times,  who  engaged  in  this  inquiry,  confined  them- 
selves to  making  hypotheses  more  or  less  ingenious,  and 
founded  them  upon  experience  and  clinical  observation.  In- 
vestigation, in  its  proper  sense,  was  only  possible  when  the 
histologic  structure  of  the  dental  tissues  was  known. 

For  a  long  period  two  hypotheses  held  a  balanced  sway  : 

2 


10  INQUIRIES    INTO    DENTAL    CARIES. 

one,  cheminai^  explained  caries  by  the  action  of  chenfical 
agents,  acids  in  particular;  the  otter,  vital,  considered  dental 
caries  as  a  veritable  malady,  caused  by  an  organic  change, 
and  the  reaction  of  the  dental  tissues  against  an  external 
irritation. 

The  defenders  of  the  chemical  theory  did  not  trouble 
themselves  about  the  vital  properties  of  the  dental  tissues. 
Some  denied  that  the  developed  organs  had  any  such  prop- 
erties; others  thought  they  possessed  so  little  energy  that 
the}'-  must  always  yield  under  the  action  of  injurious  agents, 
without  being  able  to  react  in  any  manner  against  this  irri- 
tation. 

For  them  the  process  followed  its  course  just  as  though 
the  vital  properties  had  never  existed. 

These  different  opinions  remain  to-day  unsolved  in  spite 
of  the  researches  which  have  been  made  upon  this  subject. 
It  is  true,  that  in  these  later  days,  the  chemical  theory  has 
seemed  to  have  the  upper  hand,  although  quite  recently  an 
attempt  has  been  made  to  reinstate  the  vitalist  theory  by 
the  aid  of  histologic  investigations.  But  by  the  side  of  these 
two  hypotheses,  other  observers,  particularly  in  Germany, 
assert  the  parasitic  character  of  caries,  attributing  it  step  by 
step  to  the  action  of  animal  or  vegetable  parasites. 

The  results  published  by  these  latter  authors  have  not  as 
yet  been  criticized  very  vigorously  ;  for,  accepted  too  hastily, 
in  Germany  especially,  they  seem  completely  ignored  in  other 
countries.  Messieurs  Klencke  and  Ficinus  were  among  the 
first  to  occupy  themselves  with  the  histologic  alterations  of 
the  teeth,  and,  although  their  labors  have  no  longer  any 
more  than  a  purely  historic  interest,  we  will  yet  give  a  short 
résumé  of  them. 

Ficinus  attributed  dental  caries  to  a  putrefaction  pro- 
duced by  the  minute  infusorial  animalcules  which  live  in 
the  mouth  and  to  which  he  has  given  the  name  of  Denticola. 
These  infusoriae  are  found  in  great  numbers  in  the  mucus 
which  covers  the  teeth,  as  well  as  in  the  carious  cavities. 
They  produce,  according  to  him,  a  kind  of  putrefaction 
which,  after  having  first  attacked  the  enamel  cuticle,  pro- 


INQUIRIES    INTO    THE    NATURE    OF    DENTAL    CARIES.       11 

ceeds  to  consume  the  enamel  itself  and  afterwards  the  den- 
tine. He  thinks  that  the  fibres  described  bj  Biihlraann,  and 
which  are  no  other  than  the  filaments  of  the  Leptothrix  huc- 
calis,  derive  their  origin  from  the  infusorife  which  he  calls 
denticola^  and  that  the  former  are  formed  by  contact  with 
the  latter. 

But  this  theory  does  not  explain  the  disappearance  of  the 
calcareous  salts,  which  are  soluble  only  in  acids,  while  the 
process  of  putrefaction  supposes  an  alkaline  reaction. 

The  investigations  of  M.  Kleucke  were  published  a  little 
later.  This  author  adopts  several  opinions  otiered  by  M. 
Ficinus,  but  he  admits,  besides  the  process  of  putrefaction, 
several  species  of  caries. 

And  first  he  distinguishes  central  caries  from  the  common 
peripheric  caries.  The  former  commences  in  the  cavity  of 
the  pulp,  the  latter  in  the  external  portions  of  the  teeth. 

He  also  subdivides  this  latter  into  three  diiferent  kinds. 

1st.  A  soft  caries,  caused  by  putrefaction. 

2d.  A  soft  caries,  due  to  the  proliferation  of  a  vegetable 
parasite  called  protococcus  dentalis. 

AVe  must  remark  here  that  the  existence  of  this  epiphyte 
has  not  been  confirmed  by  later  observers,  and  that,  in  spite 
of  all  the  pains  which  we  have  taken  in  the  search  for  it,  we 
have  not  been  able  to  find  it. 

3d.  The  so-called  dry  caries,  with  which  the  parasites  have 
nothing  to  do.  It  is  caused  by  the  chemical  action  of  acids 
upon  the  dental  tissues. 

The  histologic  alterations  of  which  the  dental  tissues  are 
the  seat  in  caries,  were  described  for  the  first  time  with  ac- 
curacy by  Air.  J.  Tomes.  According  to  this  author,  the 
changes  of  the  enamel  are  caused,  in  the  majority  of  cases, 
by  an  imperfect  development,  with  a  greater  porosity  of  the 
tissues  ;  a  porosity  which  increases  with  the  progress  of  the 
caries. 

The  canaliculi  of  the  dentine  present  remarkable  altera- 
tions during  caries.  In  a  cross-section  we  see  them  sur- 
rounded by  a  thickish  sheath.  One  might  say  that  the  con- 
tours of  the  old  cells  of  the  dentine  are  re-established,  and 


12  INQUIRIES    INTO    DENTAL    CARIES. 

that  the  tissue  is  resolved  into  its  pi-iiiiitive  elements  of  for- 
mation. We  know,  in  fact,  that  the  dentine  is  formed  at 
the  expense  of  cylindrical  juxtaposed  cells  which  unite  dur- 
ing the  ossification  of  the  dentine  and  become  impregnated 
with  calcareous  salts.  The  dental  canaliculi  alone  remain 
free  in  the  mass  with  the  soft  fil)rils,  discovered  by  Mr. 
Tomes,  in  the  very  centre  of  these  canaliculi. 

In  a  more  advanced  stage  the  elements  lose  the  sharpness 
of  their  contours  and  the  entire  tissue  takes  a  tinelj"  granular 
aspect.  If  the  destruction  is  rapid,  we  tind,  on  the  contrary, 
the  canaliculi  expanded  and  with  badly  deiined  contours. 

The  pathologic  alteration  proceeds  along  the  canaliculi 
towards  the  cavity  of  the  pulp,  giving,  in  most  cases,  to  the 
carious  portion  of  the  dentine  the  form  of  a  brownish  cone, 
with  the  base  turned  outwards.  In  cases  where  a  more  ex- 
tended surface  of  the  enamel  has  been  attacked  at  once  by 
caries,  and  where  the  destruction  proceeds  rapidly,  the  cone 
may  exist  incompletely,  or  be  entirely  wanting. 

Around  the  cone  is  found  a  zone  relatively  transparent,  in 
which  the  canaliculi  contain  dental  fibrils  calcified,  which 
are  often  separated  into  portions  more  or  less  long,  and  in 
some  preparations  extend  be\'ond  the  extremities  of  the  ca- 
naliculi. 

Mr.  Tomes  attributes  this  calcification  of  the  canaliculi  to 
an  organic  reaction  of  the  dentine  against  the  pathologic 
irritation,  and  he  believes  that  it  retards  ov  arrests  the  prog- 
ress of  the  caries. 

Another  manifestation  of  the  vital  properties  of  the  dentine 
consists,  according  to  him,  in  the  augmentation  cf  sensibility 
in  this  tissue  which  is  observed  in  some  cases  of  caries.  He 
concludes  from  this  that  the  dentine  is  sensitive  of  itself, 
and  not  through  its  neighborhood  to  the  pulp. 

According  to  Mr.  Tomes,  acids  are  the  principal  cause  of 
dental  caries.  After  having  first  destroyed  the  vitality  of 
the  parts  the  acids  decompose  them  little  by  little.  But  we 
do  not  succeed  in  producing  artificially,  by  the  action  of 
acids  upon  the  dentine,  histologic  changes  like  those  which 
we  observe  in  carious  teeth.   jSI^evertheless,  the  decalcification. 


INQUIRIES    INTO    THE    NATURE    OF    DENTAL    CARIES.       13 

the  softening,  the  destruction  of  the  teeth  are  all  phenomena 
due  to  the  chemical  nature  of  the  process.  But  the  dental 
tissues,  while  undergoing  destruction,  react  against  the  ac- 
tion of  the  destroying  agents,  and  this  reaction  is  ma(ie 
manifest  by  the  calcification  of  the  dentinal  fibrils  in  the  parts 
which  surround  the  carious  dentine,  and  also  by  increased 
sensibility. 

The  observations  of  Mr.  Tomes  upon  the  histologic  struc- 
ture of  the  dentine  have  been  confirmed  and  in  part  com- 
pleted by  a  more  recent  work  of  M.  E.  Neumann.*  Mr. 
î^eumann  endeavors  to  prove  by  his  observations,  which 
bear  almost  exclusively  upon  the  caries  of  the  dentine,  that 
this  attection  has,  in  part  at  least,  an  inflammatory  nature. 
According  to  this  author,  the  injurious  agents  irritate  the 
dentine  and  produce  phenomena  of  organic  irritation  which 
end  by  causing  the  destruction  of  the  tissue.  lie  distin- 
guishes two  series  of  alterations,  viz.  :  1st,  those  of  the  sheaths 
of  the  dental  canaliculi  and  of  the  intertubular  substance, 
which  have  the  character  of  simple  degeneration,  and  are 
found  in  all  cases  of  caries  ;  2d,  those  of  the  fibrils  contained 
in  the  canaliculi,  produced  by  an  inflammatory  process. 

The  alterations  of  the  first  series,  identical  with  those  of 
which  Mr.  Tomes  has  given  the  description,  are  characterized 
by  a  thickening  of  the  walls  of  the  canaliculi.  Nevertheless, 
M.  ISTeumann  does  not  believe,  with  the  English  author,  that 
the  dentine  is  formed  directly  hy  the  calcification  of  the  cells 
of  the  dentine.  Accordino-  to  him  the  intertubular  substance 
is  formed  at  the  expense  of  an  exudation,  and  the  cells  of 
the  dentine  furnish  only  prolongations  which  are  transformed 
into  the  fibrils  contained  in  the  interior  of  the  canaliculi. 
According  to  Mr.  Tomes,  the  thickened  walls  of  the  ca- 
naliculi are  formed  by  the  old  cells  of  the  dentine  which 
have  acquired  new  contours.  M.  Neumann  sees  in  this  only 
a  thickening  of  the  normal  walls  of  the  canaliculi  or  dental 
sheaths,  at  the  expense  of  the  intertubular  substance,  with 
consequent  obliteration  of  the  canaliculi. 


*  Sur  la  nature  de  la  carle  dentaire  (Archiv.  fur  Klin.  Cliir.,  torn,  v,  fasc. 
l,p.  117). 


14  INQUIRIES    INTO    DENTAL    CARIES. 

The  second  series  of  alterations  consists,  according  to  ^^. 
Neumann,  in  a  thickening  of  the  dental  fibrils  in  the  interior 
of  the  canaliculi.  These  fibrils  liave  considerably  increased 
in  diameter  and  are  divided  into  little  bundles  slightly  sepa- 
rated from  each  other.  He  considers  them  as  cells  produced 
by  division  of  the  fibrils.  If  this  explanation  is  correct  we 
should  not  find  in  teeth  of  substitution,  whether  obtained 
from  man  or  animals,  alterations  analogous  to  those  of  living 
teeth.  M.  Neumann  had  had  occasion  to  examine  a  peg  of 
ivory  which,  inserted  into  a  bone  for  the  purpose  of  efiecting 
the  cure  of  a  pseudarthrosis,  had  been  attacked  by  the  caries 
of  the  bone.  iSTone  of  the  changes  observed  in  carious  teeth 
were  found.  M.  Neumann  concludes  from  this  that  experi- 
ments made  upon  substituted  teeth  would  probably  lead  to 
the  same  negative  result,  and  that  their  caries  is  essentially 
ditierent  from  that  of  living  teeth. 

At  the  beginning  of  this  year  (1868)  appeared  the  "  Trea- 
tise upon  Dental  Caries  "  by  M.  E.  Magitot.  Some  chapters 
of  this  work  had  been  published  separately  the  year  preced- 
ing. The  author  wishes  to  prove  that  the  acids  contained 
in  the  saliva,  or  mixed  with  it,  are  the  cause  of  dental  caries, 
and  that  the  nature  of  this  afiection  is  consequently  purely 
chemical.  He  has  made  experiments  with  the  object  of  arti- 
ficially producing  caries,  by  the  action,  during  a  sufficiently 
long  period,  of  diluted  acids  upon  teeth.  The  teeth  were,  iu 
fact,  destroyed,  and  the  author  observed  curious  difierences 
in  the  action  of  the  various  acids  upon  each  of  the  dental 
tissues.  The  teeth  destroyed  were  not  submitted  to  micro- 
scopical examination. 

The  book  of  M.  Magitot  contains  no  ncAv  facts  upon  the 
subject  of  the  pathologic  alterations  of  the  dental  tissues. 
He  does  not  even  mention  the  alterations  described  by 
Messrs.  Tomes  and  Neumann,  and  contents  himself  with 
saying  that  the  canaliculi  contain  sometimes  a  finely  granu- 
lated substance. 

Pie  attaches  great  importance  to  the  calcareous  deposits 
in  the  interior  of  the  canaliculi.  and  considers  them  as  the 
result  of  a  secretion  from  the  irritated  pulp.     While  the 


INQUIRIES    INTO    THE    NATURE    OF    DENTAL    CARIES.       15 

enamel  is  disappearing  under  the  action  of  acids,  the  irrita- 
tion is  conveyed  across  the  dentine  even  to  the  pnlp,  which, 
reacting,  throws  out  a  calcareous  exudation.  This  exuda- 
tion fills  the  canalicnli  from  without  inwards,  towards  the 
cavity  of  the  pulp,  and,  when  they  are  entirely  filled,  it  is 
deposited  at  times  on  the  internal  wall  of  the  pulp-cavity 
under  the  form  of  dentine  of  new  formation.  The  deposition 
of  calcareous  salts  in  the  interior  of  the  canaliculi,  and  the 
production  of  true  dentine  in  the  pulp-cavity,  are,  according 
to  M.  Magitot,  two  analogous  phenomena. 

The  portions  of  the  dentine  containing  these  canaliculi  ob- 
literated by  calcareous  deposits,  form  a  cone  or  zone  of  trans- 
parent substance,  which  must  be  destined  to  arrest  or  retard 
the  march  of  the  malady.  M.  Magitot  does  not,  therefore, 
attribute  caries  exclusively  to  chemical  destruction.  He  ad- 
mits at  the  same  time  the  irritation  of  the  pulp  which,  by  a 
cal(^areous  exudation,  can  arrest  the  destructive  progress. 
The  cavity  of  the  pulp  once  opened,  inflammatory  symptoms 
manifest  themselves,  after  which  the  rest  of  the  tooth,  no 
longer  protected  by  the  pulp,  undergoes  decomposition  by 
the  acids. 

Before  concluding  our  résumé  let  us  remark  upon  a  strange 
idea,  started  a  little  while  ago  in  England.  It  would  explain 
not  only  the  destruction  but  also  the  formation  of  the  teeth 
b}^  electricity.  This  publication,  coming  from  Mr.  K.  Bridg- 
man,  has  been  indorsed  by  the  Odontological  Society  of  Lon- 
don. The  author  has  demonstrated  by  his  experiments  that 
teeth  can  be  destroyed  by  electrolysis.  But  his  whole  sys- 
tem is  based  upon  a  series  of  hypotheses  ;  he  attributes  en- 
tirely arbitrarily,  different  electric  properties  to  different 
parts  of  the  teeth.  The  pulp  vessels  should  be  charged  with 
negative  electricity,  the  normal  pulp  with  positive  elec- 
tricity ;  but,  in  a  pathologic  state,  the  surface  of  the  dentine 
as  well  as  the  roots  would  be  charged  with  negative  elec- 
tricity. It  is  useless  to  dwell  upon  this  work,  inasmuch  as 
no  direct  proofs  are  offered  of  the  existence  of  these  positive 
or  negative  qualities,  nor  of  the  currents  which  result  there- 
from. 


16  INQUIRIES  INTO  DENTAL  CARIES. 

If  we  review  the  numerous  and  diverse  opinions  wliich  we 
have  just  passed  in  review,  we  see  that  their  authors  differ 
in  points  the  most  essential.  We  have  said  above  that  the 
different  theories  can  bé  ranged  in  three  categories — chem- 
ical, vital,  and  parasitic — which  can  in  their  turn  be  sub- 
divided. 

In  general,  we  can  say  that  the  chemical  process  plays  an 
essential  part  in  the  production  of  caries  ;  but  it  is  a  question 
if  the  organic  processes  enter  equally  for  a  certain  share. 
We  shall  show  in  the  course  of  this  work,  that  the  organic 
process  is  nothing,  or  nearlj'  so,  and  that  a  parasitic  element 
plays  an  important  part  in  the  production  of  caries,  but  in  a 
wholly  different  way  from  wdiat  has  been  described  up  to 
the  present  time. 


II. 


ANATOMICAL   ALTERATIONS   OF   THE   TEETH 
DURING  CARIES. 

Caries,  at  least  in  a  majority  of  cases,  commences  at  the 
surface  of  the  teeth  ;  it  attacks  first  the  enamel,  which  alone 
is  exposed,  while  the  dentine  is  covered  entirely,  either  hy 
the  enamel  itself  or  by  the  cementum  ;  this  last  is  moreover 
protected  by  the  gums. 

Caries  rarely  attacks  the  exposed  portions  of  the  necks 
of  teeth,  and,  when  it  does,  naturally  has  its  origin  in  the 
cementum.  We  shall  dwell  particularly  upon  the  alterations 
undergone  by  the  enamel  and  dentine  when  attacked  by  ca- 
ries, as  these  are  the  most  important  tissues  of  the  teeth, 
and  shall  speak  of  its  effects  upon  the  cementum  only  as 
connected  with  these  tissues. 

Of  Central  Caries. 

Many  authors,  Klencke  among  others,  have  asserted  the 
existence  of  a  caries  which  originates  in  the  interior  of  the 
tooth  and  in  the  cavity  of  the  pulp.  ISTowadays  most  den- 
tists pronounce  against  the  existence  of  a  central  caries.  It 
is  true  that  the  process  of  destruction  often  begins  in  a  mi- 
nute crevice  or  furrow  in  the  surface,  and  so  penetrates  the 
dentine  even  to  the  pulp-cavity,  where  it  performs  its  rav- 
ages, while  the  enamel  of  the  surface  seems  intact,  at  least 
to  a  superficial  examination.  This  caries,  although  central, 
has  yet  its  origin  at  the  surface  of  the  tooth.  Therefore,  in 
these  latter  days,  the  existence  of  a  true  central  caries  ha& 
been  generally  denied. 

Although  in  most  cases  the  caries  called  central  is  so  only 
in  appearance,  there  are  cases,  very  rare  it  is  true,  where  the 


18  INQUIRIES    INTO    DENTAL    CARIES. 

destructive  process  lias  commenced  in  the  dental  pulp  itself. 
In  support  of  this  'opinion  we  will  cite  the  following  obser- 
vation, the  sole  case  which  has  presented  itself  during  the 
long  practice  of  one  of  us.  Therefore  it  must  be  concluded 
that  such  cases  are  extremely  rare. 

A  lady  of  21  years  of  age  presented  herself  and  complained 
of  three  teeth,  one  inferior  and  two  superior  incisors  which 
had  an  extraordinary  bluish  tinge.  They  were  not  painful, 
and  one  only  caused  any  disagreeable  sensation  to  the  pa- 
tient. She  had  consulted  several  dentists,  who  had  told  her 
that  her  teeth  were  dead,  and  there  was  no  remedy.  At  the 
surface  of  these  teeth  no  trace  of  caries  was  to  be  found. 
The  blue  color  alone  met  the  view  and  proved  their  death. 

In  piercing  the  posterior  face  of  one  of  these  teeth  it  was 
found  completely  softened,  even  to  the  enamel,  and  the  tis- 
sues had  a  brownish  color.  The  root  itself  was  hollowed  to 
a  considerable  extent.  The  same  was  found  to  be  the  case 
with  one  of  the  other  teeth.  The  third,  whose  color  was  not 
so  marked  and  which  caused  no  unpleasant  sensation,  Avas 
let  alone.  As  the  cause,  the  patient  referred  to  a  blow  from 
a  fall  which  she  had  had  in  childhood,  and  which  was  fol- 
lowed by  a  swelling  of  the  face.  The  pierced  teeth  were 
filled  with  gold.  As  for  the  inferior,  there  subsequently  de- 
veloped an  abscess  which  was  treated  by  puncturing  the  root. 

It  follows,  from  these  observations,  that  the  vessels  and 
nerves  of  the  pulp  had  been  lacerated  at  the  time  of  the  fall 
of  the  patient,  which  lesion  was  followed  by  the  death  of  the 
pulp.  But  this  might  have  taken  place  without  the  destruc- 
tion of  the  dentine  following.  We  cannot  explain  in  this 
case  the  cause  of  the  destruction  of  the  dentine,  for  the  teeth 
could  not  be  examined  by  the  microscope.  Facts  of  this 
kind  must  never  be  confounded  with  those  of  ordinary  den- 
tal caries,  which  is  due  essentially  to  the  action  of  destruc- 
tive agencies  acting  from  the  ex'terior. 

"We  believe  then  that  there  exist  cases  where  the  dental  tis- 
sues are  attacked  and  destroyed  from  the  cavitj'  of  the  pulp  ; 
but  these  cases  are  extremely  rare,  and  the  conditions  of  their 


CARIES    OF    THE    ENAxMEL.  19 

production  are  not  jet  well  understood,  except  perhaps  the 
previously  necessary  death  of  the  tooth. 

Cauies  of  the  Enamel. 

Since  caries  begins  ordinarily  at  the  crown  of  the  teeth, 
the  caries  of  the  enamel  constitutes  the  first  stage  of  the 
process.  The  destruction  reaches  the  dentine  later,  but  the 
first  pathological  phenomena  make  their  appearance  in  it, 
even  before  the  enamel  is  destroyed  in  its  whole  thickness. 
Most  frequently  there  is  seen  a  black  or  brownish  point  in 
one  of  the  furrows  or  folds  of  the  crown.  On  examining  a 
section  of  the  diseased  portion  the  dark  color  is  seen  to  have 
its  seat  in  the  superficial  layers  of  the  enamel,  and  pene- 
trates clear  to  the  bottom  of  the  furrow,  where  the  thickness 
of  the  enamel  is,  in  general,  less  than  at  other  poiiîts. 

If,  on  the  contrary,  the  caries  begins  on  a  smooth  surface, 
the  approximal  face  of  the  tooth,  for  example,  there  appears 
an  opaque  spot  of  a  yellowish  or  brownish  shade.  The  points 
where  anomalies  of  form,  of  thickness,  of  quality  of  dentine 
exist,  are  the  preferred  seats  of  caries.  The  dark  color  of 
the  spots  increases  with  the  progress  of  the  disease  ;  some- 
times the  centre  is  of  a  dark  brown  while  the  periphery  has 
a  yellowish  or  whitish  tinge.  The  harder  the  enamel  the 
darker  is  the  color,  for  in  a  dense  enamel  the  progress  of  the 
caries  is  slower  and  the  intensity  of  the  color  increases  more 
rapidly  than  the  process,  which  is  a  long  time  in  extending 
itself  to  the  periphery,  and  to  any  depth. 

The  carious  spots  are  easily  distinguished,  for  in  them  the 
enamel  has  utterly  lost  its  normal  appearance  ;  it  is  trans- 
formed into  a  chalky  mass,  analogous  to  that  which  forms 
the  congenital  white  spots  of  the  enamel,  which  are  also  a 
frequent  seat  of  dental  caries  At  the  carious  points  the 
enamel  also  possesses  less  hardness  than  in  the  normal  con- 
dition ;  but  it  is  sometimes  so  resistant  that  it  is  almost  im- 
possible to  detach  fragments  at  the  surface.  Often  the  super- 
ficial seats  seem  to  otter  greater  resistance  than  those  whicli 
are  deeper,  which,  the  former  once  removed,  permit  them- 
selves to  be  more  easily  excavated. 


20  INQUIRIES    INTO    DENTAL    CARIES. 

In  other  cases  the  consistency  of  the  enamel  is  much  fee- 
bler ;  it  is  no  more  than  a  chalky  mass,  or  even  of  no  greater 
consistency  than  paper-pulp.  These  ditterences  are  exj)lained 
partly  by  the  stage  of  destruction,  the  density  of  the  enamel 
diminishing  with  its  progress  ;  but  the  pre-existing  differ- 
ences of  the  chemical  composition,  or  consistency  of  the 
tooth,  take  an  equal  part,  for  the  enamel  is  softened  much 
more  rapidlj'  in  some  teeth  than  in  others.  At  the  begin- 
ning, the  surface  of  the  enamel  is  smooth  and  uniform  ;  the 
fine  and  parallel  stria3  which  are  ordinarily  noticed  on  its 
surface,  are  well  defined  ;  there  is,  as  yet,  no  loss  of  sub- 
stance. This  stage,  in  which  the  alterations  maj'  reach  even 
to  a  considerable  depth  in  the  dentine,  is  generally  described 
under  the  name  of  dry  caries.  The  more  the  tooth  resists 
the  longer  is  the  duration  of  this  stage;  but, in  many  cases, 
this  stage  has  but  a  short  life,  and  the  disease  rapidly  passes 
on  to  the  humid  form. 

Soon  the  portions  of  the  enamel  transformed  by  the  caries 
are  destroyed  ;  there  is  a  loss  of  substance  sometimes  spread 
over  the  surface,  or  forming  a  carious  cavity,  but,  generally, 
this  destruction  has  little  extent  before  the  dentine  has  been 
attacked  in  its  turn.  In  this  latter  case  the  caries  progresses 
rapidly,  and  extends  itself  in  depth  and  laterallj'.  The  por- 
tions of  the  enamel  situated  at  the  borders  of  the  cavity  are 
undermined  at  their  base,  or  greatly  softened  on  their  in- 
ternal surface,  and  break  in  because  they  have  no  longer  the 
natural  support,  the  dentine. 

We  may  distinguish  two  forms  in  the  destruction  of  the 
enamel  ;  on«  progressive,  extending  itself  over  the  surface,  the 
other  penetrating.  The  former  shows  itself  especially  in  cases 
where  the  caries  has  attacked  a  smooth  surface  of  the  eiiamel, 
the  latter  is  found  where  the  caries  has  commenced  in  a 
furrow.  In  the  former  case  the  caries  has  attacked,  at  the 
beginning,  a  considerable  part  of  the  surface,  and  the  de- 
struction will  be  quite  extensive  before  it  has  penetrated  as 
far  as  the  dentine.  In  the  latter  case,  on  the  contrary,  the 
alteration  of  the  enamel  is  limited  by  the  sides  of  the 
furrow.     The  enamel  is  generally  thin  at  this  point,  so  that 


HISTOLOGIC    CHANGES    IN    CARIES    OF    THE    ENAMEL.       21 

the  dentine  rapidly  becomes  exposed,  and  its  quick  destruc- 
tion causes  the  phenomena  of  the  caries  of  the  enamel  to  pass 
to  the  second  form. 

When  a  carious  cavity  is  formed  in  the  enamel,  it  is  not 
unusual  to  see  this  tissue  become  carious,  sooner  or  later  in 
one  or  several  other  points  ;  these  new  points  of  disease  pro- 
gress by  themselves,  or  add  their  forces  to  those  already  in 
existence.  It  is  more  rare  to  see  the  caries  spread  itself  at 
once  over  a  large  surface  ;  there  are,  nevertheless,  cases 
where  the  greater  part  of  the  enamel  is  attacked  or  de- 
stroyed by  caries,  and,  at  the  same  time,  one  or  several 
carious  cavities  formed.  In  such  cases  there  are  generally 
faults  of  formation  of  the  enamel,  which  presents,  at  several 
points,  depressions,  hollows,  &c.,  or  anomalies  of  structure. 
Each  one  of  these  points  may  then  originate,  either  simul- 
taneously or  successively,  the  production  of  caries. 

Histologic  Changes  in  Caries  of  the  Enamel. 

Great  importance  has  generally  been  attributed  to  the 
enamel  cuticle,  discovered  by  ISTasmyth,  in  the  production  of 
caries,  some  regarding  it  as  a  protecting  covering,  others  as 
the  seat  of  the  disease. 

The  cuticle  of  the  enamel  is,  as  is  known,  a  very  thin 
membrane,  whose  existence  is  easily  shown  by  immersing  a 
tooth  for  a  short  time  in  a  weak  solution  of  hydrochloric 
acid.  We  can  thus  readily  detach  the  cuticle  from  the 
tooth's  surface.  This  membrane,  according  to  the  investi- 
gations of  M.  Waldeyer,  must  be  the  vestige  of  the  first 
formative  strata  of  the  enamel,  and  particularly  of  the  in- 
termediate layer  and  the  external  epithelium.  After  the 
development  of  the  enamel  has  been  completed  the  elements 
of  these  strata  are  transformed  into  a  pavement-epithelium 
composed  of  two  or  three  layers  of  large  polygonal  cells, 
which  cover  the  surface  of  the  enamel.  These  cells  become 
smooth,  little  by  little,  till  their  nuclei  are  diilicult  to  be 
seen;  and,  during  the  dental  evolution,  they  unite  into  a 
membrane  of  homogeneous  appearance,  in  which  is  to  be 


22  INQUIRIES    INTO    DENTAL    CARIES. 

seen  neither  nucleus  nor  cell,  and  in  whicli  Mr.  Waldejer, 
by  means  of  a  solution  of  silver,  has  been  able  to  render 
again  visible  the  cell  contours. 

It  is  generally  thought  that  the  cuticle,  on  account  of  its 
great  resistance  to  chemical  agents,  must  protect  the  teeth. 
In  fact,  according  to  Ficinus,  neither  maceration  nor  boiling 
in  water  atlected  it,  and  concentrated  mineral  acids  did  not 
dissolve  it.  Potassa  and  soda  gave  it  a  whitish  appearance, 
and  caused  it  to  swell,  but  without  making  it  lose  its  con- 
sistency. But  it  must  be  remembered  that  if  this  membrane 
cannot  be  attacked  by  acids,  it  permits  itself  to  be  pene- 
trated by  diffusion  ;  we  must  not  then  lay  too  much  stress 
upon  its  role  of  protection.  If  the  acids  can  reach  the 
enamel  by  passing  through  it,  as  the  method  for  the  isolation 
of  the  membrane  has  already  proved,  it  can  at  the  most  re- 
tard their  action,  but  cannot  hinder  it  completely.  It  may 
then  be  useful  in  cases  where  the  acids  act  onlj-  in  a  transi- 
tory manner  ;  as,  for  example,  when  they  have  been  intro- 
duced into  the  mouth  with  the  food,  or  where  they  have 
come  from  the  stomach,  as  happens  in  certain  diseases,  and 
are  immediately  removed  from  the  mouth.  But  if  a  con- 
tinuous acid  reaction  takes  place  in  the  mouth,  as  happens 
in  the  case  of  fermentation,  then  the  protective  office  of  the 
cuticle  is  nil. 

In  many  cases  we  cannot  even  invoke  the  protective  office 
of  the  cuticle,  for  it  is  often  worn  away  on  the  masticating 
surface  of  the  teeth,  and  may  be  wanting  entirely  to  a 
greater  or  less  extent.  This  cuticle  is  frequently  wanting  in 
the  furrows  or  chinks  of  the  masticating  surface,  which  are 
also  the  favorite  seats  of  caries.  It  has  been  deduced  from 
this  fact  that  caries  is  developed  on  account  of  the  absence 
of  the  cuticle,  but  this  chosen  seat  is  explained  as  well  by 
the  presence  of  the  furrows  which  favor  the  development  of 
fermentations  and  chemical  decompositions. 

It  is  astonishing  to  see  authors  defending  the  protective 
rôle  of  the  cuticle,  and  at  the  same  time  admitting  that  it 
is  the  seat,  the  abiding-place  of  caries.  ^lessrs.  Ficinus  and 
Klencke  share  this  opinion.     They  admit  with  Erdl,  that  at 


LEPTOTHRIX    BUCCALIS.  23 

the  beginning  of  caries,  the  cuticle,  at  the  surface  of  the 
brown  spots,  is  covered  Avith  a  deposit  whose  nature  they  do 
not  agree  upon.  Ficinus  says  this  deposit  is  formed  of 
vibrios,  and  of  the  fibres  called  by  Biihlmann  filaments  of 
the  leptothrix.  According  to  Klencke  it  consists  of  these  ele- 
ments sometimes,  bnt,  in  other  cases,  there  are  found  the 
cells  of  his  pretended  yrotococcus  dentaUs. 

It  is  in  fact  easy  to  show  that,  at  the  point  of  the  carious 
spots,  the  cuticle  is  almost  always  covered  with  the  accumu- 
lated deposits  of  leptothrix  huccalis  ;  there  is  found  there  a 
substance  finely  granular,  or  bed  of  fungi,  which  is  composed 
of  very  minute  sporules.  At  the  surface  of  this  granular 
substance  there  are  also  to  be  found  at  times  very  delicate 
filaments  which  spring  from  it,  and  which  are  identical  with 
the  fibres  of  Biihlmann.  As  this  fungus*  plays  a  very  im- 
portant part  in  the  production  of  caries,  w^e  will  proceed  to 
study  it  more  in  detail. 

Leptothrix  Buccalis. 

There  is  almost  ahvays  found  in  the  mucus  of  the  mouth, 
at  the  surface  of  the  tongue,  and  in  the  interstices  of  the 
teeth,  a  whitish,  cheesy  substance,  formed  in  great  part  by 
the  leptothrix  buix-alis.  Under  the  microscope  we  see  a  gray, 
finely  granular  mass,  gangue  or  matrix,  then  filaments  deli- 
cate and  stifi",  of  various  lengths,  which  erect  themselves 
above  the  surface  of  this  granular  substance,  so  as  to  resemble 
an  uneven  turf.  It  is  in  the  interstices  of  the  teeth  that 
this  fungus  attains  its  greatest  size,  when  we  do  nothing  to 
check  its  development  ;  its  filaments  there  attain  consider- 
able length,  and  form  bundles,  sometimes  parallel  and  uudu- 

*  It  may  astonish  some  to  see  us  designate  the  leptothrix  huccalis  by  the 
name  of  fungus,  and  not  by  that  of  alga.  Opinions  are  divided  on  this 
question  which,  for  the  rest,  seems  to  have  no  great  importance  for  our  sub- 
ject. We  have  simply  used  the  name  most  common  in  German}',  without 
permitting  ourselves  to  judge  a  question  purely  botanic.  Yet,  if  it  should 
come  to  be  shown  that  the  opinion  of  M.  Hallier  is  correct,  which  is  that  the 
leptothrix  is  only  a  form  of  develo])menl  of  the  fungus  penicilliiDii  glaucuin, 
it  must  be  admitted  as  without  doubt  tluit  the  leptothrix  is  a  fungus. 


24  INQUIRIES    INTO    DENTAL    CARIES. 

lous,  at  others  firmly  interlaced  among  one  another.  On  the 
surface  of  the  tongue  we  see  cylindrical  or  club-shaped  ele- 
ments, which  are  epithelial  prolongations  of  the  filiform 
papillae  of  the  tongue,  as  IvoUiker  has  proved. 

These  prolongations  are  covered  by  a  rather  thick  mass  of 
granular  substance  of  leptothrix,  bristling  at  times  with  short 
filaments.  In  the  fluids  of  the  mouth,  detached  filaments 
are  often  met.  The  epithelial  cells  of  the  mouth  are  also 
frequently  covered  with  numerous  fine,  oblong  granulations, 
identical  with  those  which  compose  the  bed  of  the  fungus. 
If  we  closely  examine  the  grayish  masses  which  the  granu- 
lations form  at  the  surface  of  the  filiform  papillfe,  we  see 
that  they  are  composed  of  epithelial  cells,  detached  in  part, 
and  dissociated,  covered  with  thick  masses  of  granulations 
which  unite  and  make  of  them  a  compact  mass.  The  club- 
shaped  prolongations  which  result  have  often  very  well- 
marked  contours,  and  the  granulations  are  so  intimately  in- 
terwoven that  the  substance  often  appears  homogeneous,  but 
the  addition  of  a  little  acidulated  liquid  permits  the  granular 
elements  to  be  readily  isolated.  The  cheesy  matter  which 
collects  in  the  interstices  of  the  teeth  has  an  analogous 
structure,  except  that  the  granulations,  instead  of  attaching 
themselves  to  the  epithelial  cells,  are  joined  to  the  filaments 
of  the  fungus,  cover  and  unite  tham. 

It  is  easy  to  follow^  the  formation  of  this  substance.  "We 
observe,  under  the  microscope,  filaments  upon  which  granu- 
lations have  fixed  themselves  ;  some  enveloped  by  a  sheath 
of  granulations,  some  united  and  intermingled  with  them. 
Frequently  a  great  portion  of  the  cheesy  substance  is  exclu- 
sively composed  of  the  granulations,  fine,  and  generally  a 
little  drawn  out,  of  which  we  have  spoken. 

These  granulations  are,  according  to  M.  Hallier,*  only 
movable  spores  in  repose,  which  wander  during  a  certain 
period  in  the  liquid,  but  finally  attach  themselves  some- 
where and  increase  by  forming  new  articulations.  If  these 
observations  are  exact,  as  we  are  inclined   to  think,  the 

*  Die  pflanzlichon  Parasiton  des  mensohliclu'ii  Krerpors.  Lcijizig-,  180G, 
p.  66. 


LEPTOTHRIX    BUCCALIS.  25 

inoval)l6  spores  resemble  vibrios  which  are  found  in  the 
nnicns  of  the  nioutli,  and  possess  the  power  of  rapid  move- 
ment. These  organisms,  called  dtnticolcc  by  M.  Ficinus,  be- 
long then  not  to  the  animal  but  rather  to  the  vegetable 
kingdom.  Moreover,  M.  Ficinus  compared  them  with  the 
so  called  filaments  of  Biihlmann,  or  filaments  of  leptothrix. 
He  had  seen  spores,  which  he  considered  infusoria,  move  for 
a  time  in  the  liquid  among  the  filaments  of  the  leptothrix 
and  epithelial  cells,  and  afterwards  attach  and  fasten  them- 
selves to  one  of  the  filaments.  Soon  others  were  added,  and 
thus  was  explained  the  formation  of  the  filaments  and  epi- 
thelial cells  covered  with  granulations  of  which  we  have 
just  spoken  M.  Ficinus  also  believes  that  the  filaments  are 
due  to  the  juxtaposition  of  the  granulations,  which  is  not 
correct.  It  appears,  on  the  contrary,  that  the  granulations 
push  out  prolongations,  and  that  thus  is  formed  successively 
an  articulated  chain.  As  M.  Ficinus  took  the  denticolœ  for 
infusoria,  he  could  not  have  had  a  just  idea  of  the  nature  of 
the  fibres  of  Biihlmann.  Later  the  vegetable  nature  of  the 
filaments  was  recognized,  but  that  of  the  granular  substance 
could  not  be  explained.  M.  Robin  among  others  thought 
it  was  formed  by  the  débris  of  alimentary  substances.  This 
supposition  is  false  ;  for,  if  this  were  so,  the  granular  sub- 
stance would  not  always  present  the  same  characteristic 
aspect.  Composed,  in  fact,  of  granulations,  fine,  elongated, 
and  shining,  it  has  a  peculiar  matted  appearance,  by  which 
it  is  easily  recognizable. 

According  to  M.  Hallier,  to  whom  we  owe  the  opinions 
just  given  upon  the  spores  of  leptothrix,  this  fungus  may  be 
only  a  form  of  development  of  the  yenidlliinn  glaucinn  If 
so  this  fungus  should  always  be  produced  when  the  spores 
0Ï  penicilliam  are  kept  in  a  watery  liquid.  We  have  not 
verified  the  truth  of  this  opinion.  However  this  may  be,, 
M.  Hallier  explains  by  his  theory  the  formation  of  the- 
granular  substance,  and  teaches  us  the  nature  of  the  denticolœ 
of  ]\[.  Ficinus. 

It  remains  to  explain  wh}',  in  the  mouth,  the  spores  so 
quickly  lose   their   movements;   in    the    cheesy    substance^ 


26  INQUIRIES  INTO  DENTAL  CARIES. 

where  the  granulations  are  found  closely  packed,  no  move- 
ments are  perceived.  A  portion  of  the  elements  which  move 
about  in  the  saliva,  as  vibrios  are  larger  than  the  little  granu- 
lations of  the  leptothrix,  which  can  nevertheless  change  both 
form  and  volume. 

In  cultivating  the  leptothrix  in  the  saliva  with  tlie  addition 
0Î  sugar,  or  any  other  appropriate  liquid,  we  ordinarily  see 
developed  movable  spores  in  numberless  quantities,  and  en- 
dowed with  a  power  of  very  rapid  motion.  If  the  move- 
ments cease,  which  is  observed  on  the  edges  of  the  prepara- 
tion where  it  begins  to  dry,  the  spores  resemble  exactly  the 
granular  masses  of  the  leptothrix  which  are  met  with  in  the 
mouth.  The  cessation  of  movement  in  the  mouth  can  be 
explained  b}^  the  viscosity  of  the  medium,  and  by  the  pres- 
ence of  the  buccal  mucus.* 

We  have  already  observed  that  it  is  always  very  easy  to 
recognize  the  elements  of  the  leptothrix  by  their  characteristic 
aspect  ;  but  it  is  always  desirable  to  have  at  hand  a  chemical 
reagent  which  will  enable  us  to  perceive  the  existence  of  the 
fungus  when  its  external  aspect  is  deceptive.  This  reagent 
we  have  found  in  iodine  and  the  acids,  which  give  to  the 

*  Tlie  detail??  which  we  have  just  given  explain  equally  well  the  various 
opinions  which  have  been»  expressed  upon  the  conipositi(jn  of  the  tartar  of 
the  teeth,  and  upon  the  inferior  orders  of  being  wliich  it  contains.  Accord- 
ing to  M,  Mandl,  the  tartar  may  be  composed  of  the  calcareous  carapaces  of 
infusoria  which  live  by  millions  in  the  mucus  of  the  mouth,  ftl.  Ficinus 
had  the  same  opinion,  as  his  dentir.olœ  are  evidently  the  equivalent  of  the  in- 
fusoria of  M.  Mandl.  Formerly  the  tartar  was  rescarded  as  a  deposit  of  salts 
dissolved  in  the  saliva;  its  chemical  composition,  analogous  to  that  of  the 
inorganic  products  of  the  salivary  liquids,  still  pleads  in  favor  of  this  opinion. 
M.  Eobin  found  in  the  tartar  tilaments  of  leptothrix,  and  doubted  the  indi- 
cations of  M.  Mandl.  According  to  our  researches  there  do  exist  in  the 
tartar  filaments  and  granulations  of  leptothrix.  They  are  easily  recognized 
after  treating  the  tartar  with  diluted  acids.  It  is  probable  that  it  ma}'  con- 
tain at  times  more  filaments,  at  others  more  granulations  of  leptothrix,  so 
that  there  may  occur  cases  where  there  can  be  found  only  granular  masses, 
which  would  very  closely  resemble  the  indications  of  M.  Mandl.  The  infu- 
soria with  calcareous  shells  must  be  rejected.  As  for  the  salts  of  the  tartar, 
they  are  precipitated  very  jirobably  in  the  saliva,  mixed  with  viscous  mucus 
which  incloses  the  filaments  of  leptothrix,  and  dejiosited  gradually  upon  the 
burlace  of  the  teeth. 


LEPTOTHKIX    BUCCALIS.  27 

elements  of  Icptothrix  a  beautiful  violet  tinge.  We  obtained 
this  reaction  in  trying  the  eiFeet  of  that  for  cellulose  (colored 
blue  by  iodine  and  sulphuric  acid)  npon  our  fungus,  and  we 
have  noticed  that  MM.  Leyden  and  Jatfé  had  already  recom- 
mended the  same  reagent  for  the  leptothrix  vrhich  is  found 
in  putrid  sputa,  and  in  the  lungs.*  They  are  treating  of 
fungi  which  are  discovered  in  sputa  which  have  become 
putrid  in  cases  of  gangrene  of  the  lungs,  'i  he  sputa  had  a 
very  acid  reaction.  The  fungi  were  colored  a  beautiful 
violet  by  the  simple  addition  of  iodine.  The  fungi  of  the 
mouth  which  have  undergone  no  change  are  colored,  for  the 
most  part,  3'ellow  by  iodine  ;  generally  we  notice  a  violet 
color  only  after  adding  an  acid.  Sometimes  we  obtain  a 
violet  reaction  by  the  aid  of  iodine  alone,  a  fact  which  we 
must  attribute  to  acidity  of  the  buccal  mucus.  It  is  not 
necessary  to  make  use  of  sulphuric  acid,  as  in  the  case  of  the 
reaction  of  cellulose  ;  but  any  acid  whose  action  is  not  too 
violent  will  render  the  same  service.  We  have  obtained  ex- 
cellent effects  by  the  use  of  weak  hydrochloric  acid,  by 
acetic,  and  by  lactic  acid.  Sulphuric  acid  has  with  us  less 
generally  succeeded,  because  it  occasions  so  rapidly  other 
decompositions.  The  reaction  which  we  have  obtained  is 
identical  with  that  which  MM.  Leyden  and  Jafie  have  de- 
scribed, for  the  color  is  likewise  that  of  a  beautiful  violet 
(not  blue  as  in  the  action  with  cellulose),  and  it  is  the  con- 
tents of  the  iilaments  and  not  their  envelope  which  is  colored. 
We  know  this  by  the  circumstance  that  the  sejJta  of  the  fila- 
ments remain  inaccessible  to  all  coloration.  It  results  from 
this  that  the  presence  of  an  acid  is  indispensable  to  obtain 
the  reaction.  JSTevertheless  it  will  be  useless  to  have  recourse 
to  any  acid  when  the  liquid  which  contains  these  fungi  is 
acid  enough,  as  is  the  case  in  putrid  sputa,  and  even,  at 
times,  in  the  mucus  of  the  mouth. 

We  almost  always  find,  as  we  have  already  observed,  at 
the  surface  of  the  carious  points  of  the  enamel,  a  coating  of 


*  Vide  Leyden  and  Jaffé.  Sur  les  crachats  putrides,  la  gangrene  pulmo- 
naire et  la  bronchite  putride.  (Archives  ixUemandes  de  clinique  médicale. 
Tomes  ii,  iv,  and  v,  1866,  p.  488.) 


28  INQUIRIES  i>:to  dental  caries. 

leptothrix,  even  when  this  surface  seems  still  polished  and 
intact.  This  coating  adheres  strongly,  and  is  not  so  casily 
renioved  as  the  cheesy  masses  of  leptothrix  which  cover  other 
parts  of  the  surface.  AVhen,  by  the  aid  of  a  weak  acid,  the 
enamel  cuticle  is  I'emoved,  we  find  this  coating  thickened, 
composed  most  frequently  of  the  accumulations  of  granular 
matters,  and  there  is  rarely  to  be  recognized  the  presence  of 
filaments  of  leptothrix:.  The  fungi  seem  to  have  penetrated 
through  the  enamel  cuticle,  as  they  adhere  to  it  strongly  ; 
but,  at  this  stage,  it  is  not  possible  to  prove  their  presence 
in  the  enamel  itself. 

The  filamentous  and  granular  matters  of  lejjtothrix  which 
are  found  accumulated  on  the  cuticle  of  the  tooth  are  not 
arranged  in  any  regular  manner  ;  we  often  see  them  under 
the  form  of  rounded  and  irregularly  disposed  masses. 
Neither  are  these  masses  well  defined,  but  are  joined  one  to 
another  by  delicate  beds  of  granular  matter.  It  is  probable 
that  these  appearances  have  formed  the  base  of  the  observa- 
tions of  MM.  Erdl,  Ficinus,  and  Ivlencke;  but  they  have  not 
given  us  exact  descriptions  of  them.  We  have  never  been 
able  to  perceive  the  presence  of  the  cells  described  and  pic- 
tured by  M.  Klencke  in  his  Protococcus  dentalis,  and  we  think, 
after  investigations  made  upon  a  great  number  of  teeth  which 
have  all  ^ùelded  us  identical  results,  that  his  conclusions  are 
founded  in  error.  We  are  the  more  convinced  of  the  cor- 
rectness of  our  own  results,  in  that  no  observer  has  succeeded 
in  confirming  the  facts  as  stated  by  M.  Klencke.  Yet  it  is 
hard  to  say  what  could  have  given,  rise  to  this  error,  inas- 
much as  there  exists  absolutely  nothing  which  offers  any 
analogy  to  the  facts  as  stated.  M.  Klencke  describes  cells 
of  from  jl^  to  3^0'"  i^^  diameter,  which  would  be  collected, 
at  the  beginning  of  the  caries,  in  simple  beds  crowded  to- 
gether upon  the  enamel  cuticle,  and,  later,  these  same  cells 
would  form  layers  superposed,  and  vcapable  of  multiplying 
by  division  or  by  endogenous  proliferation.  The  mode  of 
propagation  of  these  cells  penetrating  the  dental  substance 
is  described  and  pictured  with  so  great  exactness  that  we 


LEPTOTHRIX    BUCCALIS.  29 

may  be  permitted  to  wait,  at  least  until  the  discovery  again 
of  some  analogous  elements. 

We  find,  occasionally,  after  having  removed,  by  the  aid  of 
a  weak  acid,  the  cuticle  which  covers  the  tooth,  minute  ele- 
ments, crowded  against  each  other  upon  the  denuded  surface, 
which  might  be  confounded  with  a  sort  of  granular  epithelium 
with  ill-defined  contours.  These  are  nothing  but  the  extremi- 
ties of  the  enamel  prisms  left  adhering  to  the  cuticle.  It  is 
impossible  to  confound  them  with  the  cells  of  the  fungus. 
It  might  with  equal  probability  be  supposed  that  such  an 
error  could  spring  from  portions  of  vegetable  or  other  ali- 
mentar}^  substances  which  are  found  adhering  to  the  teeth. 
It  seems  to  ns,  from  certain  indications,  that  the  round, 
granular  masses  of  leptothrix  which  form  upon  the  surface  of 
the  cuticle  have  given  rise  to  this  error,  although  a  certain 
power  of  imagination  is  necessary  to  consider  these  irregular 
and  badly  defined  masses  as  cells.  In  caries  of  the  enamel 
these  fungi,  as  we  shall  show,  appear  not  to  play  a  part  as 
important  as  in  that  of  the  dentine.  The  action  of  acids  and 
the  decomposition  of  oi-ganic  substances,  which  is  its  conse-  ■ 
quence,  and  which  is  recognized  by  a  brown  color,  seem  to 
us  to  demand  more  attention.  Yet  equal  account  should  be 
made  of  the  efl:ect  produced  by  the  fungi. 

The  seat  of  leptothrix  seems  generally  to  be  confined  to  the 
surface  of  the  tootb  as  long  as  the  dental  substance  remains 
intact.  It  may  be  otherwise  when  the  teeth  are  covered  with 
a  o;reenish  coatino;,  and  the  lesion  seems  to  have  its  seat  in 
the  very  substance  of  the  enamel. 

We  meet  with  this  greenish  coating  in  j'oung  people  and 
upon  the  front  teeth.  It  is  generally  attributed  to  the  alter- 
ation of  the  enamel  cuticle.  The  action  is  not  bounded  by 
the  surface  of  the  tooth,  but  penetrates  even  into  the  sub- 
stance of  the  enamel.  We  have  examined  but  a  single  case 
of  this  kind.  We  removed  from  the  surface  of  the  tooth 
small  green  and  rather  hard  portions  which  resembled  tar- 
tar, but  which  appeared  to  be  rather  minute  fragments  of 
enamel.  JSTevertheless  it  was  impossible,  after  examining 
them  under  the  microscope,  to  decide  whether  it  was  enamel 


30  INQUIRIES    INTO    DENTAL    CARIES. 

or  not.  After  having  dissolved  out  the  calcareous  portions, 
we  were  convinced  that  the  whole  substance  was  strewn  with 
granular  matter  oî  leptothrix.  The  greenish  tinge  was  found 
only  at  the  surface  of  the  pieces  ;  the  acids  could  not  destroy 
it  ;  it  had  an  appearance  of  shreds,  delicate  and  plicated,  or 
perhaps  granular,  and  without  other  structure.  It  is  im- 
portant, therefore,  to  make  new  experiments  to  ascertain  if, 
at  the  place  of  this  green  color,  the  fungi  penetrate  the  sub- 
stance of  the  enamel,  or  if  we  must  attribute  it  to  a  particular 
kind  of  tartar,  as  appears  much  less  probable.  If  the  iirst 
supposition  should  be  confirmed,  we  must  seek  to  find  why 
and  how  the  fungi  succeed  in  penetrating  the  enamel.  It 
will  not  be  less  interesting  to  know  the  origin  and  the  cause 
of  this  greenish  color. 

As  regards  the  elements  of  the  enamel,  no  particular  change 
seems  to  precede  its  alteration.  It  can  only  be  shown  by  the 
aid  of  the  microscope  that  it  is  easier  to  recognize  in  minute 
fragments  of  diseased  enamel  the  structure  of  this  tissue,  than 
in  its  fragments  in  a  state  of  health,  when  the  union  of  the 
prisms  can  with  difficulty  be  perceived.  This  phenomenon 
can  be  explained  by  the  disappearance  of  the  calcareous  salts 
consequent  upan  the  work  of  caries.  Carious  enamel  appears 
under  the  microscope  like  that  which  has  been  submitted  to 
the  action  of  acids,  and  diliers  only  by  a  little  more  or  less 
brownish  color.  The  farther  the  work  of  caries  has  pro- 
ceeded, the  easier  it  is  to  prove  this  difterence.  There  are 
found  in  minute  cavities  of  the  enamel  delicate  débris  of  this 
tissue.  The  extremities  of  the  enamel  prisms  and  their  ob- 
lique strife  have  contours  so  fine  that  it  is  only  by  the  shade 
of  brown  that  we  can  recognize  them.  This  occurs  likewise 
when  we  employ  acids.  We  find  no  more  than  a  residue, 
very  delicate  and  of  a  membranous  nature,  which  reveals 
the  composition  of  the  enamel,  whose  total  destruction  is 
not  slow  in  taking  place. 

The  porosity  of  the  carious  enamel,  which  makes  this 
tissue  lose  its  normal  transparency  and  its  hardness,  is  the 
same  as  in  enamel  exposed  to  weak  acids.  It  is  quite  easy 
to  detach  from  it  portions  which,  under  a  moderate  pressure, 


LEPTOTllRIX    BUCCALIS.  31 

are  reduced  to  minute  débris.  By  these  processes  the  enaniel 
prisms  separate  only  exceptionalh'  ;  the  fragments  have,  for 
the  most  part,  a  direction  inclined  and  oblique,  and  the 
isolated  prisms  appear  onlj^  under  the  form  of  very  short 
fragMuents  The  porosity  cannot  then  be  attributed  to  a 
diminution  of  cohesion  between  the  enamel  prisms,  but  we 
may  admit,  as  very  probable,  that  fissures  or  meshes  of  a 
very  great  delicacy  traverse  the  enamel  in  directions  the 
most  varied,  and  completely  independent  of  its  histological 
composition.  The  porosity  is  equally  due  to  the  action  of 
acids.  It  is  produced  by  the  dissolution  of  the  calcareous  salts, 
and  perhaps  by  the  production  of  carbonic  acid,  which  may 
cause  the  dissociation  of  the  smaller  particles  of  the  enamel. 
The  brownish  color  of  carious  enamel,  which  exists  also  in 
carious  dentine,  arises  probably  from  the  change  of  the 
organic  portion  of  these  tissues.  In  no  case  is  this  color 
caused  by  the  leptothrix,  which  remains  colorless,  or  causes  a 
slightly  yellowish  shade  only  when  in  beds  of  great  thick- 
ness. In  a  good  number  of  cases,  and  notably  in  carious 
cavities,  the  leptothrix  appears  to  produce  a  yellow  color,  but, 
on  attentively  examining,  we  shall  be  convinced  that  this 
color  proceeds  from  the  surrounding  diseased  materials. 
We  can,  on  the  other  hand,  in  microscopic  preparations, 
easily  distinguish  by  their  brown  color  the  residues  of  dental 
tissues,  which  are  covered  wdth  massesof/(?/9to^/(n'.r,  while  the 
leptotfirix  alone  will  have  a  grayish  appearance.  The  color 
will  vary  in  intensity,  as  we  have  already  shown,  and,  in 
general,  it  will  be  dark  in  proportion  to  the  hardness  of  the 
tooth,  the  age  of  the  caries,  and  the  time  the  color  has  had 
to  develop  itself.  When  the  enamel  has  not  yet  undergone 
decomposition,  Ave  ordinarily  observe  this  color  only  upon  the 
upper  layers,  without  doubt  because  the  cuticle  contains  a 
greater  proportion  of  organic  elements  subject  to  change. 
We  might  think  that  this  was  caused  also  by  the  easy  access 
of  the  air  to  the  parts;  nevertheless,  and  contrary  to  this 
opinion,  we  can  say  that  this  color  is  formed  anew  in  the 
dentine  after  having  disappeared  from  the  deeper  parts  of 
the  enamel,  and  that  it  gradually  lessens  as  it  extends  to  the 


32  INQUIRIES    INTO    DENTAL    CARIES. 

cavit}^  of  the  dental  palp  (Plate  I,  Fig.  2\  where,  upon  a 
point  of  the  left  side  of  the  crown,  the  brown  color  of  the 
enamel  diminishes  little  bj  little  from  the  surface  to  the  deep 
parts,  and  becomes  again  more  intense  at  the  surface  of  the 
dentine. 

When  the  caries  has  occasioned  a  loss  of  substance  at  the 
surface  of  the  enamel,  the  bottom  of  the  cavity  is  always 
covered  bj'  the  granular  masses,  and  by  filaments  of  leptothrix, 
which  penetrate  the  inequalities  and  excavations  of  the  sur- 
face. The  minute  cavities  frequently  found  in  the  depths  of 
the  enamel  are  filled  with  lepioihrix,  and  with  débris  of 
enamel  mixed  with  it.  It  is  in  general  very  difiicult  to 
recognize  by  the  aid  of  the  microscope  the  elements  of  the 
enamel  when  they  have  become  greatly  softened.  Yet,  in 
cases  where  the  oblique  striation  is  well  pronounced,  w^e 
sometimes  find  fragments  of  enamel  colored  brown,  and 
almost  entirely  deprived  of  calcareous  matters.  Masses  of 
leptofhrix  envelop  them,  and  contribute,  by  their  prodigious 
proliferation,  to  their  destruction. 

In  our  opinion  the  progress  of  caries  of  the  enamel  is  this: 
By  the  action  of  an  acid  the  enamel  becomes  porous  at  some 
point,  and  loses  its  normal  consistence.  At  the  same  time 
there  is  seen  to  appear  a  brown  color,  in  consequence  of  the 
change  which  has  taken  place  in  its  organic  structure. 
There  is  formed  at  the  surface  a  bed  of  leptofhrix,  which 
probably  penetrates  the  dental  cuticle,  if  it  still  exists,  and 
destroys  it.  Chinks  and  fissures  are  opened  in  the  enamel, 
which  has  become  less  consistent.  Acid  liquids  and  granu- 
lations 0Î  leptothrix  penetrate  there,  while  minute  fragments 
become  detached,  and  are  promptly  enveloped  by  the  elements 
of  leptothrix,  which,  joined  to  the  continued  action  of  the 
acids,  hasten  the  dissolution.  There  are  many  cases  where 
the  work  may  be  stationary  for  a  long  time,  and  perhaps  for 
always,  corresponding  to  that  of  the  caries  called  dry,  char- 
acterized only  by  the  brown  color  of  the  surface,  and  a  little 
more  porosity,  which  should  be  attributed  to  the  more  decided 
action  of  acids.  In  answer  to  what  we  have  just  said  may 
be  cited  the  alterations  of  the  enamel  which  appear  almost 


CARIES    OF    THE    DENTINE.  33 

immediately  after  the  commencement  of  the  diseased  action, 
when  the  brown  color  has  hardly  had  time  to  become  formed. 
We  can  attribute  these  difterences  in  the  progress  of  the  dis- 
ease only  to  particular  predispositions,  due,  it  may  be,  to 
vicious  structure,  or  to  ditfering  consistency,  or  resistance  of 
the  enamel. 

Caries  of  the  Dentine. 

In  the  dentine  the  work  of  caries  begins  generally  as  soon 
as  that  of  the  enamel  has  pentrated  to  its  surface.  Particular 
circumstances  enable  us  to  ascertain  whether  any  alteration, 
properly  so  called,  and  loss  of  substance  at  the  surface  of  the 
enamel,  have  or  have  not  preceded  this  morbid  action.  We 
can  also  divide  into  two  periods  the  action  of  caries  in  the 
dentine,  viz.,  that  of  the  preparatori/  work  of  the  caries,  and  the 
loeinod  of  âestractioii.  Before  decaying  the  dentine  also  under- 
goes certain  transformations  wdiich  can  be  recognized,  as  in 
the  alterations  of  the  enamel,  b}'  a  brownish  color  more  or 
less  marked,  and  by  a  lessening  of  consistency,  due  to  the 
loss  of  a  portion  of  the  calcareous  salts.  We  observe,  more- 
over, when  the  disease  has  j^rogressed  to  a  certain  degree, 
certain  histologic  changes  which  were  thought  to  l)e  the 
result  of  an  active,  vital  action,  and  which  can  only  be 
attributed  to  the  proliferation  of  the  leptothrix. 

These  same  vegetations  play  also  a  very  important  part  in 
the  definitive  alteration  which  takes  place  in  caries  of  the 
dentine.  The  caries  ordinarily  proceeds  from  the  enamel  to 
the  dentine;  more  rarely  it  has  its  point  of  departure  in  the 
cement,  when  this  has  become  exposed,  or  is  defective. 
Caries  maj^  also  commence  directly  in  the  dentine  Avhen  it  is 
denuded,  whether  by  a  vice  of  conformation,  or  by  an  external 
lesion.  The  march  of  caries  is  still  more  rapid  in  the  dentine 
than  in  the  enamel.  Starting  from  a  minute  point  upon  the 
surface,  the  caries  may  promptly  extend  through  a  great 
part  of  the  dentine;  that  of  the  enamel  cannot  make  such 
rapid  progress.  The  more  rapid  march  of  the  caries  in  the 
dentine  is  occasioned  by  its  structure.     The  minute  dentinal 


34  INQUIRIES    INTO    ÊENTAL    CARIES. 

canaliculi,  so  accessible  to  liquids,  oiler  to  the  action  of 
destructive  agents  a  much  more  extended  surface,  and  per- 
mit them  to  penetrate  to  the  depths  of  the  dentine,  an  action 
not  possible  in  the  enamel  which  has  not  these  canals. 

Another  cause,  which,  in  the  majority  of  cases,  explains 
the  more  rapid  march  of  caries  of  the  dentine,  is  this,  viz., 
the  carious  cavity  once  formed,  the  destructive  process  can 
develop  itself  freely  without  hindrance  from  the  friction  of 
the  teeth  during  mastication,  or  from  the  cleansing  of  the 
mouth.  While  at  the  surface  of  the  teeth  the  injurious  sub- 
stances are  continually  removed,  and  the  enamel  forms  upon 
the  borders  of  the  cavity  a  protecting  wall,  favorable  to  the 
development -of  caries  behind  it.  Its  canaliculous  structure 
appears,  however,  to  be  the  main  cause  of  the  more  rapid 
progress  of  caries  in  the  dentine,  and  the  observation  of  the 
facts  leaves  no  doubt  upon  this  subject.  The  caries  follows 
chiefly  tJie  direction  of  the  dentinal  cancdiculi,  and  extends  itself 
less  easily  and  with  less  rapidity  in  the  direction  of  the  width 
of  the  tooth  than  in  that  of  its  depth,  that  is  to  say,  towards 
the  cavit}'  of  the  pulp. 

If  we  divide  a  carious  tooth  in  the  direction  of  its  length, 
we  find,  as  Tomes  has  first  remarked,  that  the  dentine  altered 
by  caries,  when  no  destruction  has  as  yet  taken  place,  pre- 
sents the  form  of  a  cone  with  its  base  turned  outwards,  and 
of  a  brownish  color,  which  ow^es  its  origin  to  that  which  the 
caries  follows  in  its  progressive  march,  viz.,  the  direction  of 
the  canals  towards  the  pulp  ;  the  conical  form  is  determined 
by  the  convergent  direction  of  the  dentinal  canaliculi.  (Plate 
I,  Figs.  1  and  2,  shows,  three  times  magnified,  cones  of  den- 
tal caries  upon  a  tooth  divided  lengthwise,  with  and  without 
alteration  at  the  surface.) 

When  a  portion  of  the  dentine  has  been  destroyed  by 
caries,  it  can  no  longer  have  the  form  of  a  perfect  cone  ;  but 
there  is  always  found,  at  the  circumference  of  the  carious 
cavity,  a  zone  of  altered  substance  which  goes  on  diminishing 
in  thickness  in  the  direction  of  the  pulp.  We  find  these 
cones  in  teeth  altered  by  caries  at  a  period  when  the  exterior 
surface  of  the  enamel  has  still  all  its  polish,  and,  consequently, 


CARIES    OF    THE    DENTINE.  35 

has  lost  IK)  part  of  its  substance.*  But,  at  this  epoch,  the 
whole  thickness  of  the  enamel  is  already  changed,  and  there 
exists  no  covering  of  normal  enamel  at  the  surface  of  the 
dentine.  j\I.  Magitot  says  that  the  cone  commences  some- 
times at  a  point  at  a  distance  from  the  surface  of  the  tooth. 
We  believe  that  the  tooth  pictured  by  this  author  can  be  ex- 
plained by  supposing  that  the  section,  in  the  direction  of  its 
length,  has  not  been  made  across  the  centre  of  the  caries,  and, 
consequently,  has  not  touched  the  point  whence  the  morbid 
action  has  been  propagated  from  the  enamel  to  the  dentine. 
The  alterations  effected  by  the  caries  in  the  dentine  nui}^ 
have  extended  themselves  laterally  to  a  slight  depth,  and 
have  left  untouched  the  more  superficial  portions.  When 
we  have  made  sections  of  teeth  across  the  centre  of  the  caries, 
we  have  constantly  observed  that  the  alteration  had  its  be- 
ginning at  the  surface  of  the  dentine.  The  cones  which  we 
have  mentioned  have  also  been  spoken  of  and  described  b}' 
various  authors,  and  especially  by  MM,  Tomes  and  Magitot. 
Nevertheless  we  have  reason  for  surprise  that  these  cones 
have  not  been  considered  as  the  point  of  de[)arture  of  the 
caries  itself,  but  rather  as  the  result  of  an  organic  reaction 
which  preceded  the  caries,  and  opposed  itself  as  much  as 
possible  to  its  progress.  After  our  experiments  made  upon 
a  great  number  of  teeth  cut  across  in  every  direction,  we 
cannot  share  this  opinion.  We  think,  as  does  also  Mr. 
iSpence  Bate,!  the  cones  are  only  the  first  degree  of  the  work 
of  caries  in  the  dentine  This  results  from  their  physical 
properties  ;  the  color  is  brownish  ;  the  consistence  lessened  ; 
and  the  transparency  greater. 

We  have  found  the  broicnish  color  in  all  the  cones,  whether 
there  has  or  not  been  loss  of  substance  at  the  surface  of  the 
tooth.  In  speaking  of  the  enamel,  we  have  already  expressed 
the  o[)inion  that  the  brownish  color  is  due  to  a  decomposition 
of  the  organic  portions  of  the  tooth.  The  intensity  of  this 
color  difiers  in  the  dentine  as  in  the  enamel.    It  is  darker  as 

*  Traité  de  la  carie  dentaire,  8,  26. 

t  Ilcport  of  the  Sitting's  of  the  Odontologie  Society  of  London.  March  7, 
1864.     JJrit.  .Journal  of  Dental  Science. 


36  INQUIRIES    INTO    DENTAL    CARIES. 

the  progress  of  the  caries  is  slower  and  tlie  density  of  tlie  tooth 
greater.  As  a  general  rule  we  may  say  that  the  color  is 
diffused  ;  from  time  to  time  we  find  in  the  dental  canaliculi 
minute  granulations  of  pigment  which  are  deposited  there  in 
greater  or  less  quantity.  The  hardness  of  the  substance  lohich 
has  acquired  the  conical  form  also  varies  greatly.  When  there 
has  not  yet  occurred  any  destruction  of  substance,  nor  any 
carious  cavity,  this  hardness  may,  in  certain  circumstances, 
be  quite  marked,  above  all  in  the  deeper  seats,  and  in  teeth 
which  are  naturally  very  hard,  and  consequently  in  the  cases 
of  caries  called  dry.  Notwithstanding,  it  is  easy  to  convince 
oneself  that,  even  in  this  form  of  caries,  the  consistence  of 
the  cone,  however  hard  it  may  be,  is  always  less  than  that 
of  the  sound  portion  of  the  same  tooth.  In  other  cases,  on 
the  contrary,  all  the  substance  which  constitutes  the  cone  is 
manifestly  more  softened  than  the  dentine  in  its  normal 
state.  It  is  to  be  remarked  that  the  deeper  seats  of  the  dis- 
ease are  always  less  softened  than  those  at  the  surface.  This 
is  markedly  the  case  when  the  caries  has  hollowed  out  a 
cavity.  We  find  then,  among  the  most  sujjerficial  layers, 
always  a  softened  layer  of  dentine  which  is  on  the  way  to 
complete  dissolution.  The  thickness  of  this  layer  varies 
greatly  ;  in  moist  caries  it  is  quite  thick,  and  insensibly  ex- 
tends itself  to  the  deeper  parts  of  the  cone. 

In  the  drier  caries,  the  softeued  layer  of  the  surface  has  a 
much  less  thickness,  and  at  times  is  wanting  altogether. 
These  difl^erences  evidently  depend  upon  the  rapidity  of  the 
evolution  of  the  caries  of  the  dentine.  If  the  pathologic 
alteration  of  the  dentine  which  has  preceded  its  decomposi- 
tion has  occasioned  a  considerable  softening  of  the  substance, 
the  caries  will  naturally  make  more  rapid  strides,  and  a 
thick  layer  of  substance  undergoing  decomposition  is  upon 
the  point  of  detaching  itself  at  the  surface.  But,  if  the  den- 
tine is  very  hard  and  little  softened  by  the  work  of  the  caries, 
the  decomposition  extends  itself  but  slowly,  and  the  destroyed 
sul)stance  at  the  surface  forms  but  a  thin  layer,  and  some- 
times seems  not  to  exist  at  all. 

The  transjxirent  appearance  of  the  conical  substance  ecpially 


CARIES    OF    THE    DENTINE.  37 

proves  that  it  is  the  commencement  of  the  work  of  caries. 
It  is  especially  easy  to  recognize  it  in  thin  portions  which 
are  detached  without  difRculty  from  the  softened  carious 
substance  ;  or,  if  this  is  too  hard,  we  can  always  perceive  it 
in  sections  rubbed  down  with  pumice.  The  brownish  color 
is  scarcely  seen  in  such  thin  preparations  ;  we  see  it  well  only 
when  it  is  very  intense  ;  therefore  MM.  Tomes  and  Magitot 
have  not  attached  a  sufficient  importance  to  it. 

The  dentine,  as  regards  transparency,  has  properties  the 
very  opposite  of  those  of  the  enamel.  AVhile  the  enamel  is 
translucent  in  its  normal  state,  the  dentine  presents  an  opaque 
wdiitish  or  yellowish  shade;  the  enamel  loses  its  translucence 
by  caries,  while  the  dentine  becomes  more  translucent  and 
almost  cartilaginous.  We  have  already  remarked,  in  treat- 
ing of  caries  of  the  enamel,  that  we  must  attribute  its  loss  of 
transparency  to  the  action  of  acids.  We  shall  take  occasion 
to  show  fucther  on  that  acids  produce  the  same  effect  out  of 
the  mouth  as  in  it. 

Experiments  also  lead  us  to  the  same  results  with  the  den- 
tine. If,  by  the  aid  of  an  acid,  we  decalcify  the  dentine,  it 
becomes  transparent  and  acquires  the  aspect  and  consistence 
of  cartilage.  AVhen  the  dentine  is  incompletel}^  decalcified, 
it  resendjles,  minus  the  brown  tinge,  certain  kinds  of  dentine 
altered  by  caries.  Yet,  at  a  more  advanced  stage  of  the  dis- 
ease, carious  dentine  is  distinguished  by  less  consistence,  and, 
moreover,  by  peculiarities  of  structure,  inasmuch  as  the  action 
of  acids  alone  is  not  enough  to  produce  caries.  It  ought  not, 
therefore,  to  be  any  longer  doubted  that  the  transparency  of 
carious  teeth  should  be  attributed  to  the  loss  of  their  calca- 
reous salts. 

Mr.  Tomes  and,  after  him,  ]\I.  Magitot  have  endeavored  to 
explain  this  transparencj-  otherwise.  Mr.  Tomes  attributes 
it  to  the  calcification  of  the  fibrillœ  which  he  discovered  in 
the  interior  of  the  dentinal  canaliculi.  In  fact,  we  also  have 
been  able  to  verify  very  often,  and  notably  at  the  borders  of 
the  diaphanous  zone,  in  the  direction  of  the  still  sound  den- 
tine, the  existence  of  a  considerable  number  of  minute  cavi- 
ties and  of  granulations  ranged  side  by  side,  formed  by  cal- 


38  INQUIRIES  INTO  DKNTAL  CARIES. 

caroons  salts  and  situated  in  the  interior  of  the  dentinal 
canaliculi. 

Xeverthcless  it  is  impossible  that  the  transparency  shonld 
be  due  to  the  presence  of  these  concretions,  for  we  do  not 
always  meet  with  them,  and  when  tliey  do  exist  they  are 
not  found  in  every  part  of  the  transparent  substance.  They 
generally  show  themselves  only  in  the  form  of  a  very  slender 
zone  at  tlie  limits  of  the  portion  of  the  dentine  altered  by  the 
malady.  It  is  easy  to  recognize  in  sections  for  the  microscope 
that  the  transparency  does  not  exist  except  where  these  con- 
cretions are  seen,  and  that  these  same  concretions  form  no 
part  of  the  appearance  which  the  tissue  presents  to  the  naked 
eye.  Finally,  it  is  easy  to  demonstrate  a  jpriori  that  these 
concretions  cannot  in  any  manner  cause  the  transparency  of 
these  tissues.  They  could  do  so  only  by  rendering  them 
more  homogeneous  ;  that  is  to  say,  tlie  matters  deposited  in 
the  canaliculi  ought  to  have  the  same  index  of  fefraction  as 
the  intercellular  substance;  the  boundaries  of  the  canaliculi 
would  thus  become,  in  the  sections,  paler  and  less  obscure. 
The  opaque  aspect  of  the  dentine  in  its  normal  state  depends, 
at  least  in  part,  upon  its  structure.  It  is  composed  of  parts 
which  have  different  indices  of  refraction  (the  canaliculi  and 
the  intercellular  substance\  and  which  alternate  regularh^  in 
position.  But  the  concretions  contained  in  the  dentinal  ca- 
naliculi ought  rather  to  produce  an  opposite  elfect.  In  fact 
they  are  distinguished  under  the  microscope  by  their  dark 
margins,  which  proves  that  their  index  of  refraction  is  dif- 
ferent from  that  of  the  surrounding  substance.  They  are, 
moreover,  dispersed  in  little  parcels,  which  increase  the  ine- 
qualities of  the  structure  and  lessen  the  transparency-.  In 
this  connection  we  here  remark  the  opacity  which  is  pro- 
duced in  the  tissues  by  minute  globules  of  fat,  ranged  side 
by  side,  whose  power  of  refraction  is  well  known.  If,  in  spite 
of  this,  the  tissue  remains  transparent,  we  can  explain  the 
fact  only  by  admitting  that  the  disappearance  of  the  calca- 
reous salts  has  much  to  do  with  it,  and  it  cannot  be  sensibly 
affected  by  slight  inequalities  of  tissue. 

We  shall  recur,  in  the  course  of  this  treatise,  to  the  origin 


MICROSCOPIC    CIIAN(JES.  39 

of  these  calcareous  concretions  in  the  canalienli,  and  upon 
the  eftects  which  MM.  Tomes  and  M  agi  tot  have  sought  to 
attribute  to  their  presence.  We  confine  ourselves,  for  the 
moment,  to  asserting  that  the  transj)arency  of  the  carious 
dentine  cannot  at  all  be  attributed  to  them. 

It  results,  from  what  we  have  just  said,  that  the  cones, 
formed  of  a  brownish  and  more  diaphanous  substance,  make 
an  integral  part  of  the  commencement  of  the  Avork  of  decay, 
and  should  not  be  considered  as  a  peculiar  morbid  condition 
preceding  the  caries  properly  so  called.  All  can  easily  verify 
this  for  themselves  by  examining  a  great  number  of  sections 
of  carious  teeth,  for  thus  the  different  forms  and  periods  can 
be  followed  and  compared,  from  teeth  where  the  cones  are 
hard  and  where  doubts  may  exist,  to  those  whose  cones  are 
formed  of  a  substance  very  distinctly  softened  and  on  the 
road  to  decomposition. 

Microscopic  Changes  of  the  Dentine  in  a  Carious  State. 

The  microscopic  changes  which  are  undergone  by  dentine 
during  the  work  of  caries  are  of  great  importance  in  resolv- 
ing the  doubts  wdiich  exist  upon  the  nature  of  this  malady, 
and  especially  in  ascertaining  whether  or  not  organic  action 
is  to  be  regarded  as  among  its  causes. 

We  have  established  hereinbefore  (in  our  review  of  what 
we  actually  know^),  that  different  authors  have  ascertained 
the  existence  in  the  dentine  of  histologic  changes,  upon  the 
nature  of  which,  nevertheless,  they  are  far  from  agreement. 
Perhaps  their  differences  would  have  disappeared  if  more 
importance  had  been  attached  to  the  manner  in  which  the 
tissue  was  destroyed.  We  distinguish  in  dentinal  caries  two 
periods  which  cannot  be  rigorously  defined  ;  the  preparatory 
■peno(^  of  decalcification  and  softening ^à\xv'mg\\\\\<i'h.  the  micro- 
scopic changes  in  question  are  to  be  observed;  and  the  period 
of  direct  decomposi  ion.  Up  to  the  present  time  it  has  been 
the  custom  to  admit  in  general  that  the  dentine,  deprived  of 
its  calcareous  salts,  is  dissolved  by  a  sort  of  putrefaction. 
But  it  is  not  difficult  to  demonstrate  that  the  influence  of 


40  INQUIRIES    INTO    DENTAL    CARIES. 

leptothrix  is  very  great  in  this  work  of  destruction,  inasmucli 
as  it  penetrates  very  deeply  into  the  clefts  and  interstices  of 
the  decalcified  dentine,  which  it  reduces  into  small  fragments. 
It  is  equally  probable  that  this  same  leptothrix  plays,  by  its 
extension,  an  active  and  direct  part  in  the  absorption  of  the 
carious  tissue. 

We  shall  demonstrate  farther  on  that  a  great  part,  if  not 
the  whole,  of  the  microscopic  changes  observed  in  carious 
dentine  should  be  attributed  to  the  introduction  of  the  ele- 
ments of  leptothrix  into  the  dentinal  canaliculi,  and  in  part 
into  the  iutertubular  substance.  AVe  will  first  examine  the 
phenomena  which  characterize  the  direct  decomposition  of  the 
tissue.  We  follow,  it  is  true,  a  method  just  the  opposite  of 
that  which  the  changes  themselves  have  taken.  Yet  this 
ofters  no  inconvenience,  for  the  knowledge  of  these  phenom- 
ena is  indispensable  in  order  to  comprehend  the  changes 
which  precede  the  caries. 

If  we  examine  the  disorganized  substance  which  covers 
the  superficies  of  a  carious  cavity,  and  which,  moreover, 
presents  an  acid  reaction,  we  are  truly  astonished  at  the 
quantity  of  elements  of  leptothrix  which  are  found  there. 
The  superficial  layers,  with  the  exception  of  some  particles 
of  food,  are  formed  exclusively  by  the  granular  masses,  and 
by  the  filaments  of  leptothrix.  On  removing  these  we  come 
upon  layers  which  possess  sufficient  consistency  to  permit  us 
to  make  sections.  These  latter,  as  is  shown  in  Plate  II, 
Fig.  2,  consist  of  irregular  minute  fragments  of  carious  den- 
tine of  a  brown  color.  They  are  enveloped  and  united  by 
masses  of  lei^tothrix ;  above- all,  granular  leptothrix.  In  the 
layers  which  lie  still  deeper  the  volume  of  the  dentine  in- 
creases; the  lej^tothrix  diimnishes  in  such  a  proportion  that 
the  dentine  here  forms  the  principal  part.  We  see,  then,  in 
the  carious  portions,  colored  brown,  irregular  chinks  and 
interstices  filled  with  leptothrix  and  its  elements  (Plate  II, 
Fig.  1).  This  arrangement  may  well  be  compared  to  the 
canals  and  veins  which  are  exhibited  by  certain  stones.  The 
leptothrix  always  diminishes  in  proportion  to  the  depth;  yet 
sometimes  it  is  found  at  a  remarkable  depth,  where  it  takes 


MICROSCOPIC    CHANGES.  41 

a  direction  parallel  to  the  dentinal  canaliculi.  "We  recognize 
very  clearly  this  arrangement  in  sections  of  decalcified  teeth, 
or  in  those  ground  thin  with  pumice.  The  images  ohtained 
in  this  manner  do  not  permit  us  to  doubt  that  these  fungi 
by  their  extension  have  deepl}^  penetrated  the  dentine,  and 
have  not  confined  themselves  to  simply  filling  pre-existent 
cavities.  We  find  these  latter  nowhere,  and  we  shall  prove 
by  and  by  that  the  minute  dentinal  canaliculi  constitute  the 
principal  roads  by  wdiich  the  leptothrix  penetrates  the  dental 
tissues. 

We  often  observe  in  sections  islets  which  are  filled  with 
the  finely  granular  matter  of  the  fungus  (Plate  II,  Fig.  6). 
The  origin  of  these  islets  is  easily  explained  by  the  direction 
of  the  sections  which  cross  a  conduit  filled  with  leptothrix^ 
and  which,  in  consequence,  oft'er  the  image  of  an  isolated 
islet.  We  see  there,  moreover,  other  conduits  which  corre- 
spond with  the  surface.  Up  to  the  present  time  observers 
have  confined  themselves  to  proving  the  presence  of  the 
leptothrix  in  the  carious  cavities  of  the  tooth,  but  without 
assigning  it  any  influence  in  the  work  of  decomposition. 
The}^  have  not  noticed  the  introduction  of  the  leptothrix  into 
the  softened  substance  of  the  dentine;  and  its  presence  in 
the  carious  cavities  has  consequently  been  considered  as 
accidental  and  without  importance.  According  to  our  ob- 
servations we  cannot  refuse  to  admit  that  the  proliferation 
of  the  fungus  plays  an  important  part  in  the  decomposition 
of  the  dental  tissue.  What  explains  the  ignorance  of  authors 
upon  this  point  is  that  they  confounded  the  vegetable  granu- 
lations with  the  organic  matters  in  decomposition,  and  that 
the  elements  proper  to  leptothrix  passed  unperceived.  The 
reaction  with  iodine  and  the  acids,  which  produces  a  beauti- 
ful violet  color,  as  well  with  the  granular  masses  as  with  the 
filaments,  leaves  no  doubt  about  the  nature  of  the  granular 
leptothrix. 

The  figures  and  their  explanations  of  Ivlencke,  upon  the 
penetration  of  the  protococcus  deritalis  into  the  dentine,  have 
a  certain  analogy  with  the  images  which  we  have  just  de- 
scribed above.     The  analogy,  nevertheless,  holds  on\y  as  to 

4 


42  INQUIRIES    INTO    DENTAL    CARIES. 

the  mode  of  penetration  of  the  cells,  as  he  calls  them,  into 
the  interior  of  the  dentine.  His  Figure  15*  (loc.  cit.,  S.  57), 
might  cause  it  to  be  thought  that  he  had  under  his  eyes  the 
same  image  as  we.  Yet  all  that  concerns,  in  these  consid- 
erations and  in  these  sketches,  the  form,  &c.,  of  the  extension 
of  these  parasitic  plants  is,  as  we  have  already  remarked,  but 
the  work  of  the  imagination.  The  opinion  of  Ficinus,  who 
figured  at  the  surface  of  the  carious  dentine  a  considerable 
number  of  vibrios,  called  by  him  dentieolœ/is  explained  in  the 
simplest  manner  by  the  theory  of  M.  Hallier,  if  he  is  correct. 
According  to  this  author  the  granulations  of  the  leptothrix 
are  spores  which  have  come  to  a  state  of  repose. 

In  our  researches  upon  carious  teeth  we  have,  it  is  true, 
seen  the  granular  masses  of  the  leptothrix  stationary,  and  in 
proportion  but  a  small  quantity  of  granulations  in  movement. 
ÎNTevertheless  we  believe  that  there  may  be  great  variety  in 
the  cases,  and  that,  in  given  circumstances,  we  may  come 
across  considerable  masses  of  spores  dispersed  and  moving. 
The  observations  of  Ficinus  will  thus  become  conformed  to 
ours,  when  it  will  be  necessar}^  to  consider  the  presumed 
infusoria  as  scattered  spores  of  leptothrix. 

Let  us  pass  now  to  the  examination  of  the  changes  ichich 
take  place  in  the  dentine  before  direct  decomposition  of  the  tissue. 
The  softened  dentine  of  a  brownish  color  and  of  a  feeble  con- 
sistence, situated  under  a  carious  surface,  presents,  after  re- 
moval of  the  masses  of  leptothrix  which  penetrate  there,  pecu- 
liar changes  in  the  dentinal  canaliculi.  These  changes  become 
in  general  more  and  more  perceptible  as  we  proceed  from  the 
depths  of  the  dentine  to  its  surface.    It  is  easy  to  see  in  cross- 

*  We  have  just  learned  that  M.  Georges  Pouchet  had  expressed  a  similar 
opinion  to  ours  upon  the  nature  of  the  granulations  of  leptothrix.  He  con- 
sidered them  as  one  of  the  phases  of  development  of  the  plant.  This  author 
has  not  noticed  movements  in  the  granulations  which  compose  the  granular 
masses,  and  he  has  concluded  from  this  that  they  are  always  immovable. 
The  movements  which  others  have  observed  may  be  caused  by  vibrios  which 
have  penetrated  the  granular  mass.  New  observations  will  show  if  we  must 
receive  the  opinion  of  M.  Pouchet,  or  that  of  M.  Hallier,  who  thinks  that 
the  granulations  of  leptothrix  before  coming  to  a  state  of  repose,  move  through 
the  liquids  in  every  direction,  under  the  form  of  movable  spores. 


MICROSCOPIC    CHANGES.  43 

sections  of  teeth  that  the  ccmaliculi  become  vn y  gradually  laraer^ 
till  they  reach  a  considerable  size,  by  the  accumulation  in  their  in- 
terior of  a  finely  gi^amdar  substance.  The  canals  so  enlarged 
present  for  the  most  part  a  double  contour,  invisible  in  the 
normal  state,  a  fact  which  indicates  that  the  bore  is  bounded 
by  thick  walls.  The  thickness  of  the  walls  varies,  but  less 
than  the  calibre  of  the  canals.  Taking  for  our  point  of  de- 
parture the  portions  which  remain  sound,  we  can  observe  in 
the  sections  the  passage  of  the  dentinal  caualiculi  from  those 
without  distinct  walls  to  those  whose  walls  are  thickened, 
and  whose  dilatation  goes  on  increasing  by  means  of  the  ac- 
cumulation of  foreign  substances  (see  Plate  II,  Fig.  2).  In 
the  latter  case,  there  may  still  exist  a  wall  distinct  from  the 
material  contained  in  the  canals  ;  nevertheless,  when  the  di- 
latation is  very  great,  it  maj'  happen  that  this  wall  entirely 
ceases  to  be  visible.  Finally,  if,  in  other  cases,  the  canaliculi 
are  but  little  dilated,  while  the  walls  are  much  thickened, 
we  observe  rings  quite  large,  brilliant,  and  crowded  upon 
each  other,  which  have  a  brownish-yellow  color,  like  the  in- 
terposed substance.  Close  observation  is  necessary  to  distin- 
guish the  granular  contents  from  the  wall,  which  presents  a 
brilliant  aspect  (see  by  the  aid  of  a  feeble  magnifier  Plate  II, 
Fig.  3,  where  the  walls  are  not  at  all  visible). 

At  times  the  dilatation  is  carried  so  far  that  the  canals, 
crowded  together,  not  onlj^  touch  at  their  circumferences, 
but  become  reciprocally  flattened.  We  then  observe  in  trans- 
verse sections  polygonal  instead  of  circular  figures.  At  flrst 
sight,  we  might  be  disposed  to  think  that  the  canaliculi  be- 
come gradually  obliterated  by  the  successive  thickening  of 
the  walls,  according  to  the  opinion  of  M.  IS'eumann,*  while 
Mr.  Tomes  compares  the  dentinal  canaliculi  with  thickened 
walls  to  pipe-stems,  and  does  not  admit  of  complete  oblitera- 
tion. Xevertheless,  we  have  come  to  be  convinced  that  in 
all  cases  the  tubes  of  the  canaliculi  are  increased  and  filled 
with  a  mass  which  ordinarily  will  he  finely  granular  and 
sometimes  homogeneous,  surrounded  with  more  or  less  thick- 
ened walls. 

*  See  loc.  cit.     Archives  de  Clinique  Chirurgicale,  t.  vi,  p.  1. 


44  INQUIRIES    INTO    DENTAL    CARIES. 

The  principal  reason  which  has  caused  M.  Xeumann  to 
believe  in  the  obliteration  of  the  caualiculi  by  the  successive 
thickening  of  the  walls,  is  the  images  which  are  obtained 
after  impregnating  the  preparation  with  carmine.  The 
thickened  walls  do  not  take  the  color  from  carmine,  while 
the  matter  contained  in  their  interior  is  sometimes  very 
strongly  colored  by  it,  and  is  thus  very  clearly  distinguished 
from  the  walls.  Sometimes,  nevertheless,  the  contents  are 
but  slightly  colored  ;  it  is  then  difficult  to  distinguish  it 
from  the  thickened  and  brilliant  wall,  which  gives  rise  to 
the  belief  that  the  canal  is  completely  obliterated  ;  but  an 
attentive  examination  will  always  reveal  the  true  state  of 
things.  The  most  remarkable  varieties  of  coloration  by  car- 
mine manifest  themselves  in  the  intertubular  substance.  In 
the  normal  state  this  substance  is  colored,  feebly  it  is  true, 
by  the  carmine  ;  in  the  carious  portions,  on  the  contrary, 
and  particularly  when  the  brown  color  is  stronglj'  marked, 
this  substance  entirely  resists  coloring,  so  that  these  parts, 
including  the  dilated  canaliculi  whose  contents  remain 
equally  inaccessible  to  coloration,  contrast  by  their  yellow 
hue  with  the  surrounding  parts  colored  red.  On  the  con- 
trary, in  other  circumstances,  this  same  substance  will  take 
the  color.  This  is  the  case  with  preparations  made  from  the 
superficial  layers,  where  the  intertubular  substance  shows 
itself  spotted  throughout  with  very  fine  granulations.  It 
may  be  said  that  the  brown  color  is  opposed  to  the  red  of 
the  carmine,  for  this  latter  is  perceived  nowhere  where  the 
brown  is  strongly  marked.  AVe  must  not,  therefore,  place 
any  great  importance  upon  the  coloration  Avith  carmine. 
We  cannot  share  the  opinion  of  M.  jS^eumann  who  distin- 
guishes two  kinds  of  changes  :  1st,  obliteration  of  the  canal- 
iculi by  successive  thickening  of  the  walls  ;  and  2d,  thicken- 
ing of  the  fibrils  contained  in  the  dentinal  canaliculi,  and 
their  division  into  successive  cellular  elements. 

As  for  us,  we  attribale  all  the  changes  to  a  gradually  increas- 
ing dilatation  of  the  canaliculi  hy  the  formation  of  a  finely  gran- 
ular substance  which  is  more  or  less  strongly  colored  by 
carmine,  and  to  a  thickening  of  the  walls  of  these  same  canals. 


MICROSCOPIC    CHANGES.  45 

In  longitudinal  sections,  which  rarely  furnish  images  as 
distinct  as  oblique  ones,  we  often  see  the  contents  of  these 
dilated  canaliculi  reduced  to  the  condition  of  small  threads 
which  at  times  become  separated  by  minute  intervals.  Thus 
the  dilatation  of  the  canaliculi  may  become  very  consider- 
able ;  but  we  find  the  threads  in  the  canals  already  slightly- 
dilated,  and,  in  this  case,  carmine  colors  them  a  bright  red 
(they  correspond  to  the  cellular  elements  which,  according 
to  M.  Neumann,  come  from  the  thickening  and  division  of 
the  dentinal  fibrils).  In  cases  where  the  contents  of  the 
canaliculi  does  not  take  the  carmine  and,  as  well  as  the  in- 
termediary substance,  presents  a  yellowish-brown  shade,  we 
perceive,  in  general,  the  canaliculi  thickened  only  in  a  con- 
fnsed  manner  in  the  longitudinal  sections  ;  we  can  prove 
only  that  the  dentinal  canaliculi  are  badly  defined,  and  that 
their  contours  are  replaced  by  longitudinal  stv'vre  but  little 
marked. 

Analogous  images  under  the  form  of  bandies  of  rods,  but 
in  general  of  a  smaller  diameter  and  rebellious  to  the  action 
of  carmine,  arise  from  deposits  of  calcareous  salts  in  the 
canaliculi.     We  shall  recur  again  to  this  subject  farther  on. 

As  M.  Neumann  has  already  observed,  we  can  easily 
isolate  the  thickened  dentinal  canaliculi  by  macerating  them 
in  nitric  or  hydrochloric  acid,  just  as  is  done  for  the  normal 
ones  (Plate  II,  Fig.  5).  It  is  not  rare  to  observe  in  the  same 
canal  the  passage  from  the  minute  dimensions  of  the  normal 
state  to  a  pathologic  thickening  (Fig.  5,  b).  The  isolated 
canals  also  present  difierences  in  the  degree  of  coloration  by 
carmine,  and  very  often  the  division  of  their  contents  into 
threads  can  be  recognized.  The  contents  of  the  canaliculi 
often  projects  beyond  their  ends,  and  is  seen  under  the  form 
of  a  prominence  with  fine  granulations,  or  else  as  a  brilliant 
and  viscous  drop  ;  in  general  the  extremity  of  the  canaliculi 
is  then  contracted.  Sometimes,  also,  there  can  be  distin- 
guished throuo;h  the  walls  in  isolated  canaliculi  the  contents 
composed  of  fine  granulations. 

Another  peculiarity  belonging  to  the  thickened  canaliculi 
consists  of  partial  varicose  dilatations  and  the  sinuosities 


46  INQUIRIES    INTO    DENTAL    CARIES. 

which  they  present  ;  this  contributes  towards  rendering 
them  susceptible  of  acquiring  at  these  points  a  relatively 
considerable  thickness. 

The  mean  diameter  of  the  thickened  canalicule  of  a  tooth 
was  from  .003  to  .006  of  a  millimetre  ;  some  presented  a 
much  greater  diameter,  notal)ly  at  the  thickened  and  vari- 
cose points;  the  normal  canalicule  of  the  same  tooth  showed 
a  diameter  of  only  from  .001  to  .0015  of  a  millimetre.  To 
form  an  opinion  upon  the  nature  of  the  changes  just  men- 
tioned, it  is  of  the  highest  importance  to  well  consider  the 
condition  of  the  dentine  in  the  caries  of  natural  teeth  of  implan- 
tation. 

The  solution  of  this  question  will  lead  us  to  know  if  the 
changes  are  in  part  or  wholly  of  a  vital  nature,  or  not.  M. 
ISTeumann  has  expressed  the  same  opinion,  for  he  has  declared 
that  his  conclusions  would  cease  to  be  true  if  it  should  come 
to  be  proved  that,  in  the  caries  of  natural  implanted  teeth, 
the  same  changes  take  place  as  in  living  teeth.  It  is  a  well- 
known  fact,  long  since  observed,  that  false  teeth,  whether 
procured  from  man  or  made  from  the  ivory  of  the  elephant 
or  hippopotamus,  decay  in  the  mouth  as  well  as  the  natural 
teeth.  Caries,  indeed,  establishes  itself  very  quickly  in  these 
false  teeth,  and  begins  ordinarily  in  the  points  where  the 
teeth  are  fastened  upon  the  plates,  or  kept  in  place  by  the 
aid  of  wires.  These  places  constitute,  for  the  development 
of  morbid  phenomena,  points  of  departure  as  favorable  as 
the  clefts  in  the  enamel,  or  interstices  in  the  teeth. 

The  partisans  of  the  chemical  theory  of  caries  of  teeth 
have  always  cited,  as  proof  of  their  opinion,  the  caries  of 
natural  teeth  of  substitution.  JSTevertheless  it  could  be  ob- 
jected that  there  is  but  an  external  analogy  between  the 
caries  of  these  teeth  and  that  of  living  ones,  and  that  there 
may  exist  between  the  two  essential  histologic  ditferences. 
This  is  the  opinion  of  M.  jSTeumann.  lie  found,  especially 
in  examining  a  piece  of  ivory  inserted  in  a  bone  and  attacked 
by  caries,  that  the  characteristic  changes  of  the  dentine,  as 
they  have  been  described,  were  wholly  wanting.  lie  con- 
cluded from  this  that  the  caries  of  artificial  teeth  of  ivory 


MICROSCOPIC    CHANGES.  47 

may,  in  all  probability,  also  not  resemble  tliat  of  the  natural 
ones.  On  the  contrary,  we  have  remarked,  in  examining 
several  teeth  made  of  hippopotamus  ivory,  as  well  as  three 
human  teeth  of  substitution  which  had  all  decayed  in  the 
mouth,  that  the  microscopic  changes  of  the  dentine,  as  they 
have  been  described,  take  place  equally  in  these  artificial 
teetli.  In  every  case  the  canaliculi  were  more  or  less  dilated, 
sometimes  even  extraordinarily  so,  and  their  contents  were 
generally  susceptible  of  being  colored  by  carmine.  Above 
all,  in  preparations  made  from  hippopotamus  ivory,  we  were 
able  to  observe  these  changes  in  the  most  marked  maimer 
(Plate  II,  Fig.  6).  The  isolated  canals  were  in  part  very 
much  thickened  and  presented  the  varicosities  which  we 
have  spoken  of.  At  the  greatly  dilated  points  these  canals 
attained  a  diameter  of  .009  of  a  millimetre.  There  were  even 
some  of  them  which  measured  as  much  as  .015  ;  their  con- 
tents were  finely  granular  and  were  easily  colored  by  carmine 
(Plate  II,  Fig.  7).  It  is  true,  we  did  not  find  in  these  the 
elements  in  the  form  of  threads,  but  it  is  equally  true  that 
they  are  not  always  found  thus  in  caries  of  the  living  teeth. 
Nevertheless,  we  have  observed  these  same  thread-like  ob- 
jects in  the  canaliculi  of  carious  pivoted  human  teeth.  The 
threads  then  do  not  form  special  elements,  and  the  mass 
which  fills  the  dilated  canaliculi,  and  which  is  susceptible  of 
coloration  by  carmine,  ought  not  to  be  considered  a  substance 
of  a  difterent  nature.  In  teeth  made  from  hippopotamus 
ivory  we  do  not  see  the  walls  of  the  canals  thickened  us  in 
human  teeth  of  substitution.  In  fact,  the  pieces  made  with 
human  teetli  of  substitution  present  no  difference  from  the 
preparations  made  from  natural  teeth. 

Aside  from  these  considerations  there  exist  still  other 
reasons  for  combating  the  opinion  of  M.  jSTeumann,  who 
admits  a  vital  action  in  the  changes  we  have  just  mentioned. 

M.  Xeumann  himself  declares  that  the  transformation  of 
the  dentinal  fibrils,  deprived  of  nucleic  into  cellular  elements 
ranged  one  after  the  other,  appeared  extraordinary.  Farther, 
as  to  the  cells,  we  cannot  reasonably  expect  to  see  their  di- 
mensions vary  within  too  narrow  limits.     But,  indeed,  the 


48  INQUIRIES    INTO    DENTAL    CARIES. 

threads  are  already  seen  in  canaliculi  which  exceed  but 
slightly  their  normal  thickness,  as  well  as  in  those  which 
have  acquired  a  considerable  dilatation,  and  the  vohmie  of 
the  threads  corresponds  to  the  dilatation  of  the  canaliculi. 
From  time  to  time  we  see  the  contents  of  the  canaliculi 
divided  into  minute  and  rather  short  fragments  ;  in  other 
cases  divisions  are  noticed  only  here  and  there  at  great  dis- 
tances, and  often  they  are  entirely  wanting  for  a  large  extent. 

It  would  as  well  be  permitted  to  suppose  that,  by  the  fact 
of  maceration  in  mineral  acids,  the  cells  are  completely  de- 
stroyed, and  that  the  threads  no  longer  exist.  But  it  is  by 
no  means  so  ;  the  threads  are  excellently  preserved,  a  fact 
which  proves  that  they  are  composed  of  a  material  more  re- 
sistant than  the  substance  of  which  the  animal  cells  are 
formed. 

We  profit  by  this  circumstance  to  call  attention  to  the  fact 
that  in  artificial  teeth  caries  extends  equally  and  by  prefer- 
ence along  the  dentinal  canaliculi. 

In  the  human  teeth  of  substitution  which  we  have  had 
the  opportunity  of  examining,  the  caries  did  not  commence 
on  the  natural  surface,  but  rather  on  one  which  had  been  cut 
away  ;  thus  the  formation  of  a  cone  became  impossible,  inas- 
much as  this  can  be  produced  only  by  the  convergence  of  the 
dentinal  canaliculi  which  proceed  from  the  surface  into  the 
central  portion  of  the  tooth.  In  spite  of  this  we  could  per- 
ceive clearly  that,  at  the  points  where  the  dentinal  canaliculi 
were  perpendicular  to  the  surface,  the  changes  had  penetrated 
much  more  deeply  than  there  where  the  canaliculi  presented 
a  direction  parallel  to  the  surface. 

If,  in  accordance  with  what  has  just  been  said,  the  changes 
mentioned  do  not  owe  their  origin  to  a  vital  action,  it  be- 
hooves us  now  to  inquire  into  their  true  nature. 

One  might  think,  a  priori^  that  they  had  been  occasioned 
by  the  action  of  acids.  Nevertheless,  this  cannot  be  proved 
experimentally,  and  as  Mr.  Tomes  has  well  said,  we  do  not 
succeed  in  any  manner  in  imitating  artificially  the  caries  of 
the  teeth.  The  experiments  of  M.  Magitot,  in  Avhich  he  has 
succeeded  in  producing  profound  changes  in  teeth  submitted 


MICROSCOPIC    CHANGES.  49 

for  a  very  long  time  to  the  action  of  diluted  acids,  are  not  at 
all  conclusive,  inasmuch  as  they  are  not  supported  ])y  any 
microscopic  examination.  In  fact,  examination  under  the 
microscope  is  indispensable,  because  by  this  alone  can  we 
verify  the  changes  characteristic  of  caries.  In  the  second 
place,  it  is  possible  that  the  elements  of  lejjtothrix,  which 
take  an  essential  part  in  the  final  destruction  of  carious  den- 
tine, occasion  as  well  the  changes  of  the  canaliculi  which 
precede  this  destruction.  This  opinion  alone  is  capable  of 
explaining  the  changes  undergone  by  artificial  teeth,  and  is 
completely  confirmed  by  the  facts  ;  for  the  contents  of  the 
dilated  canals  presents  the  same  violet  reaction  as  the  lep- 
tothrix.  In  preparations  in  which  are  found  together  elements 
of  leptothrix  and  thickened  canals,  we  obtain  in  a  like  manner 
the  violet  coloration,  which  gives  us  beautiful  images  of  the 
contents  of  the  dilated  canals. 

It  is  useless  to  remark  that  we  have  satisfied  ourselves 
that  with  the  normal  dentine  such  a  reaction  never  takes 
place.  Iodine  and  the  acids  color  it  nothing  but  yellow. 
The  reaction  is  independent  of  the  coloration  of  the  contents 
of  the  dentinal  canaliculi  by  the  carmine.  In  transverse  sec- 
tions of  the  canals  the  rounded  and  brilliant  disks,  which  are 
rebellious  to  the  coloration  by  carmine,  give  the  reaction,  as 
well  as  the  dilated  canals  which  contain  a  finely  granular 
matter  susceptible  of  taking  a  vivid  color  from  carmine. 

We  easily  distinguish,  in  the  first,  the  contents  from  the 
walls,  and  these  contents  have  also  taken  a  finely  granular 
appearance. 

The  difference  of  coloration  by  the  carmine  does  not  then 
establish  'àwy  essential  difference  between  the  minute  canals. 
It,  perhaps,  has  for  its  cause,  in  part  at  least,  a  differing  state 
of  development  in  the  spores  of  the  leptothrix.  AYe  have  at 
least  noticed  that  the  masses  of  leptothrix  taken  from  the  sur- 
face of  the  tongue,  and  older,  to  judge  from  the  strong  adhe- 
sion of  their  elements,  are  less  strongly  colored  by  carmine 
than  the  more  recent  masses  whose  elements  are  more  easily 
isolated.  Iodine  alone  colors  the  canals  yellow.  There  are, 
nevertheless,  cases  where  the  violet  reaction  has  taken  place 


50  INQUIRIES    INTO    DENTAL    CARIES. 

])}'  the  simple  addition  of  iodine.  The  fungi  situated  at  the 
surface  are  generally  colored  more  strongly.  The  concen- 
trated acids,  in  which  teeth  are  placed  for  the  purpose  of  de- 
calcification, appear  to  render  the  reaction  impossible.  This 
is  the  reason,  without  doubt,  that  ^NI.  j^eum^un  obtained  no 
violet  reaction  upon  prepared  portions  of  decalcified  teeth. 

There  is,  then,  no  manner  of  doubt  that  the  elementary 
parts  of  tlie  fungus  penetrate  into  the  interior  of  the  canals, 
and  there  develop  in  a  manner  to  acquire  a  relatively  con- 
siderable diameter.  It  also  results,  from  the  very  fact  of  the 
dilatation  of  the  canals,  that  the  appearance  of  the  fungus  is 
not  accidental,  and  that  it  is  not  by  a  purely  passive  action 
that  it  invades  the  canals.  It  is  necessary  that  there  be  a 
proliferation  of  spores  infinitely  minute  and  innumerable  of 
the  fungus  to  efiect  the  dilatation  of  the  dentinal  canals.  It 
is,  moreover,  very  important  that  the  elements  of  the  lep- 
tothrix  should  have,  at  a  certain  stage,  a  mol)ilit.y  of  their 
own,  in  virtue  of  which  they  easily  penetrate  the  interior  of 
the  canals.  As  for  the  rest,  we  have  met  in  the  canals  with 
only  the  granular  masses  of  the  leptothrix,  and  never  the 'fila- 
ments which  appear  to  show  themselves  only  at  the  surface.* 

According  to  experiments  actually  made  are  also  explained 
the  formation  of  conduits  and  clefts  filled  with  granular  masses 
of  leptothrix^  which  are  found  in  the  superjicial  layers  of  carious 
dentine. 

They  spring  from  the  dilatation,  gradually  increasing,  of 

*  The  fungi  described  by  MM.  "Wedl  and  Heider  (see  Wedl  "  upon  a 
fungus  developed  in  the  dentine")  (Comptes  rendus  de  l'acadeniie  de  Vienne, 
1864,  t.  1,  p.  173-193)  bave,  according  to  the  description  of  these  authors, 
notbing  in  common  with  the  Icptothrix  These  develop,  after  some  days,  in 
the  cement  and  dentine  of  sound  teeth  which  have  been  extracted  and  placed 
in  water.  The  fungi  from  tbe  cement  penetrate  the  dentine,  after  ten  days, 
to  a  depth  of  from  .2  to  .25  of  a  millimetre.  Portions  of  dentine  which  were 
exposed  to  their  invasions  wore,  after  three  or  four  weeks,  pierced  like  a 
sieve.  These  experiments  come  to  the  aid  of  ours,  inasmuch  as  they  prove 
tbat  fungi  can  develop  in  tbe  cement  and  dentine,  even  when  these  tissues 
still  possess  all  their  calcareous  salts. 

The  soft  filament:-  which  Mr.  Tomes  has  found  in  tbe  interior  of  tbe  canals 
are  probably  too  tender  to  resist  the  invasion  of  the  elements  of  lepiothrix, 
and  appear  therefore  to  be  promptly  destroyed. 


MICROSCOPIC    CHANGES.  51 

certain  minute  canals.  Under  the  influence  of  this  morbid 
action,  the  walls  and  a  part  of  the  surrounding  tissue  com- 
pletely disappear.  It  will,  then,  be  wrong  to  conclude  from 
this  the  introduction  of  the  fungus  into  pre-existing  Assures. 
We  can,  in  fact,  observe  all  the  transitions  between  the  den- 
tinal canals  greatly  dilated  and  the  conduits  tilled  with  lep- 
tothrix^2i\\(\.  thus  assist  at  the  development  of  these  conduits. 
At  the  outset  these  latter  alwa3's  follow  a  direction  parallel 
to  the  dentinal  canals  ;  in  consequence,  at  certain  points, 
more  marked  dilatations  are  found  corresponding  to  the 
varicosities  of  the  dilated  canals.  jSTeio-hboring:  conduits 
may  meet  at  these  points  and  anastomose  with  each  other. 
By  the  incessant  development  of  leptotlirix  the  softened  den- 
tine becomes  decomposed  into  irregular  parcels,  which, 
towards  the  surface,  become  more  and  more  minute  and 
finally  separate,  completing  the  destruction  of  the  tissue. 

We  conceive  that  the  dilatation  of  the  dentinal  canals, 
found  in  the  tissue  situated"  immediately  below  the  carious 
surface,  may  be  more  or  less  pronounced  and  not  always 
reach  the  highest  degree  of  •  development.  If,  in  certain 
canals,  the  extension  of  the  leptothnx  is  more  considerable, 
the  intermediate  parts  may  be  isolated  and  undergo  decom- 
position, even  when  the  canals  have  undergone  but  a  mode- 
rate extension.  The  decomposition  of  the  substance  may,  it 
is  true,  likewise  commence  at  the  very  beginning  of  the 
carious  surface,  which  is  constantly  covered  with  a  prodigious 
quantity  of  leiJtothrix.  It  frequently  happens  that,  in  the 
layers  of  the  surface,  the  leptothnx  also  infiltrates  the  whole 
intertubular  substance,  which  then  presents  a  granular  ap- 
pearance, and  the  contours  of  the  canals  thus  become.very 
confused.  In  these  cases  iodine  and  the  acids  produce  upon 
the  whole  tissue  a  violet  reaction. 

The  thickenino^  of  the  walls  can,  it  is  true,  have  for  its 
cause  an  action  purely  mechanical  following  upon  the  dis- 
tension of  the  canals  and  the  consequent  thickening  of  the 
environing  substance.  Yet,  w^e  must  remark,  that  we  have 
observed  similar  walls  where  the  canals  have  not  been  at  all 
dilated.     In  cases  where  the  action  of  caries  has  just  com- 


52  INQUIRIES    INTO    DENTAL    CARIES. 

menced,  we  have  seen  a  portion  of  the  canaliculi  moderately 
dilated  and  filled  as  usual  with  leptothrix.  Other  canals,  on 
the  contrary,  had  a  normal  calibre;  they  may  even  have 
been  a  little  narrow,  very  pale,  and  surrounded  with  glisten- 
ing walls  ;  whilst  the  walls  of  the  dilated  canals  were  dif- 
ficult to  distinguish.  Nevertheless,  we  are  not  quite  sure 
that  the  phenomenon  is  analogous  to  that  which  presides 
over  the  dilatation  of  the  canals.  By  the  aid  of  maceration 
in  hydrochloric  acid  the  canals  are  easily  isolated  ;  they  pre- 
sent their  normal  delicacy  ;  whilst  there,  where  the  canals 
are  dilated,  the  walls  are  isolated  at  the  same  time  with 
the  canals  ;  in  the  former  case  the  wall  evidently  offers  less 
resistance  to  the  action  of  the  acid  than  in  the  latter. 

Accordino-  to  Mr.  Tomes  the  thickening  of  the  walls  in 
caries  is  the  result  of  the  regeneration  of  the  contours  of  the 
organic  cellules  of  the  dentine. 

M.  Xeumann  declares,  on  the  other  hand,  that  the  dentinal 
walls  are  thickened  at  the  expense  of  the  intercellular  sub- 
stance. These  authors  explain  differently  the  manner  in 
which  dentine  is  formed  by  the  aid  of  dentinal  cells,  and  it 
is  YQYY  difficult  to  say  what  is  or  is  not  the  truth  among  such 
different  statements.  The  opinion  of  Mr.  Tomes  is  based 
upon  the  following  supposition  :  According  to  him  the  den- 
tinal cells  are  penetrated  with  calcareous  salts,  except  an  in- 
terior portion  which  is  left  free,  and  which  forms  the  dentinal 
canaliculi  with  the  fibrils  which  are  found  there.  At  the 
same  time  there  is  seen  to  form  a  certain  quantity  of  inter- 
cellular substance  which  is  impregnated,  as  well  as  the  cells, 
with  calcareous  salts,  and  becomes  so  fused  together  with 
them  that  their  proper  contours  disappear. 

M.  Neumann,  on  the  contrary,  considers  all  the  intercellu- 
lar substance  as  the  product  of  a  secretion  ;  as  for  the  cells 
of  the  dentine  they  send  out  very  delicate  prolongations 
which  go  to  form  the  fibrils  found  in  the  canaliculi.  How- 
ever this  may  be  the  question  still  remains  how  the  connec- 
tion of  the  fused  cells  comes  to  he  dissolved  ;  or,  if  the  opinion 
of  M.  Neumann  is  preferred,  from  whence  springs  the  thick- 
ening of  the  dentinal  walls?     AVe  have  already  remarked 


MICROSCOPIC    CHANGES.  53 

that  acids  give  rise  to  uo  such  alterations.  To  recapitulate, 
it  appears  to  us  very  probable  that  the  thickening  of  the 
walls  of  the  dilated  canals  is  produced  mechanically,  on  ac- 
count of  the  pressure  of  the  surrounding  substance.  Here, 
nevertheless,  we  are  obliged  to  acknowledge  that  in  some 
rare  cases  there  are  found  walls  thickened  without  the  canals 
being  dilated,  and  we  confess  our  ignorance  of  the  cause. 
Perhaps  we  may  be  permitted  to  suppose  a  chemical  action 
by  the  elements  of  the  IcptotJirix  upon  the  environing  tissue. 

We  have  already  remarked  that  during  the  action  of  caries 
there  are  often  formed  calcareous  deposits  in  the  interior 
of  the  dentinal  tubes,  deposits  which  Mr.  Tomes  and  M. 
Magitot  have  regarded  as  of  great  importance.  They  are 
seen  ranged  singly,  or  in  groups,  under  the  form  of  minute 
threads,  or  bundles  of  them,  more  or  less  long  ;.  or  else  under 
the  form  of  separate  cylindrical  granulations.  On  submitting 
them  to  the  action  of  acids  they  dissolve,  and  leave,  most 
frequently,  an  organic  residue,  which  preserves  the  same 
form. 

At  times  the  masses  of  leptothrix  contained  in  the  dilated 
canals  are  also  impregnated  with  calcareous  salts  ;  but  oftener 
we  meet  these  deposits  in  the  undilated  canals  of  the  deep 
layers  of  dentine  changed  by  caries.  We  likewise  find  from 
time  to  time  minute  calct^reous  granulations  in  the  inter- 
globular spaces  of  the  dentine.  They  are  observed  most  fre- 
quently in  sections  of  carious  teeth  in  which  the  changes  are 
not  far  advanced.  In  these  cases  they  are  always  found  in 
a  zone  which  surrounds  this  altered  portion  of  the  dentine 
whose  canaliculi  are  dilated,  and  show  a  very  intense  brown 
color  (see  Plate  I,  Fig.  4,  which  represents  a  portion  of  the 
dental  section  pictured  in  Fig.  3;  we  see  here  that  the  cal- 
careous deposits  do  not  begin  to  appear  until  at  a  certain 
depth  from  the  surface).  If  the  change  of  the  dentine  has 
but  just  begun  we  sometimes  meet  the  calcareous  deposits 
throughout  the  greater  part  of  the  cone.  We  have  already 
demonstrated  that  the  transparency  of  carious  dentine  cannot 
be  attributed  to  the  presence  of  calcareous  salts  in  the  inte- 
rior of  the  canals.     These  deposits  should  rather  diminish 


54  INQUIRIES    INTO    DENTAL    CARIES. 

the  transparency  ;  and  yet  the  zone  which  contains  them  is 
more  transparent  than  in  the  normal  state.  We  can  there- 
fore attribute  it  only  to  the  abstraction  of  a  portion  of  the 
calcareous  salts.  These  deposits  of  calcareous  salts  in  the 
interior  of  the  dentinal  canaliculi  are  considered  by  Mr. 
Tomes,  and  after  him  by  M.  Magitot,  as  the  product  of  a 
vital  action.  But  inasmuch  as  these  same  calcareous  salts 
are  likewise  found  in  carious  artificial  teeth,  we  can  also 
adduce  here  all  the  objections  already  made  against  the  vital 
character  of  the  other  changes  which  we  have  descril)ed. 

AVe  are  still  more  inclined  to  believe  that  these  calcareous 
deposits  are  formed  by  a  purely  chemical  process;  that  is  to 
say,  by  the  residue  resulting  from  the  solution  of  the  calca- 
reous salts  by  contact  with  acids. 

In  the  work  of  caries  a  portion  of  the  calcareous  salts  of 
the  teeth  is  always  dissolved  out  ;  these  same  salts,  so  dis- 
solved, must  bj'  difiusion  penetrate  the  canals  towards  the 
cavity  of  the  pulp;  there  in  contact  with  the  neutral  or  alka- 
line liquid  which  fills  the  interior  of  the  canals,  or  which 
penetrates  the  dentinal  fibrils,  a  precipitate  is  formed.  If  we 
drop  upon  the  section  of  a  sound  tooth,  placed  under  the 
microscope,  a  little  concentrated  acid,  then,  shortly  after, 
some  drops  of  water,  we  see  a  great  number  of  needle-shaped 
crystals  immediately  form,  which  arrange  themselves  in  the 
form  of  rosettes. 

These  crystals  must  be  composed  of  phosphate  of  lime.  In 
glasses,  in  which  we  have  for  some  time  preserved  carious 
teeth  in  water  slightly  acidulated,  we  have  seen  an  abundance 
of  these  same  crystals  precipitate  themselves  upon  still  farther 
weakenino;  the  solution  bv  the  addition  of  water.  The  cal- 
careous  salts  which  have  been  dissolved  by  the  acids  are  pre- 
cipitated by  the  simple  addition  of  a  neutral  liquid,  and  still 
more  by  the  mixture  of  a  liquid  slightly  alkaline.  From 
this  it  is  easy  to  understand  why  the  calcareous  deposits  are 
always  found  at  the  extremity  of  that  part  of  the  dentine 
which  is  altered  b}''  caries  ;  and  it  is  not  necessary  to  admit 
that  they  are  formed  in  the  pulp-cavity. 

Mr.  Tomes  compares  the  calcareous  deposits  which  form 


MICROSCOPIC    CHANGES.  55 

at  the  extremity  of  the  diseased  dentine  to  the  work  of 
exfoliation  in  the  parts  bordering  upon  a  portion  of  necrosed 
bone  or  gangrened  tissue.  In  the  two  cases  the  reaction 
takes  place  in  the  surrounding  sound  parts,  Avith  this  differ- 
ence, nevertheless,  that  in  dental  caries  there  is  no  elimina- 
tion of  the  diseased  tissues 

M.  Magitot,  on  the  contrary,  believes  that  the  calcareous 
deposits  spring  from  the  pulp;  this  being  irritated  gives  out 
a  calcareous  exudation  which  at  first  fills  the  canals,  from 
W'ithout  inwards,  and  which,  in  fine,  according  to  circum- 
stances, is  deposited  as  dentine  of  new  formation  upon  the 
interior  surface  of  the  pulp-cavit}'.  It  is,  nevertheless,  abso- 
lutely proved  that  the  calcareous  deposits  in  the  interior  of 
the  canals  cannot  be  identified  with  the  new  layers  of  dentine 
w-hich  are  formed  at  the  surface  of  the  pulp-cavity.  These 
formations,  in  fact,  as  well  as  the  normal  dentine,  take  their 
origin  from  the  dentinal  cells  of  the  pulp.  If  the  calcareous 
deposits  arise  from  the  pulp,  why  are  they  at  first  so  far  from 
it?  and  why  are  they  not  always  found  in  its  immediate 
vicinity?  As  for  the  rest,  all  explanations  of  this  class  are 
formally  refuted  by  the  formation  of  calcareoui^  salts  in  the 
caries  of  artificial  teeth,  and  it  is  therefore  useless  to  seek 
for  other  explanations.  Calcareous  deposits  are  more  abun- 
dant in  proportion  as  the  progress  of  the  caries  is  slower,  and 
they  develop  themselves  in  an  especial  manner  when  the 
caries  remains  at  rest  during  a  certain  time. 

The  protection  w'hich  these  calcareous  deposits  seem  to 
furnish  to  the  dentine  can,  consequently,  be  of  no  great  ac- 
count. As  soon  as  the  caries  makes  new  progress,  they  are 
dissolved,  and  probablj"  with  more  facility  than  the  normal 
calcareous  salts  of  the  dentine.  From  the  fact  that  these 
deposits  manifest  themselves  more  particularly  when  the 
march  of  the  caries  is  slow,  it  has  been  concluded  that  they 
oppose  the  morbid  action  ;  while  according  to  our  views  the 
slow  march  of  the  caries  has,  on  the  contrary,  for  its  effect, 
the  formation  of  the  calcareous  deposits. 

It  remains  now  to  examine  if  the  phenomena  ichich  ice  have 
just  described^  and  which  relate  to  the  action  of  acids  and  of  the 


56  INQUIRIES  INTO  DENTAL  CARIES. 

leptothrix,  are  the  only  ones  which,  are  to  be  observed  in  caries  of 
the  dentine,  and  if,  hereafter,  ice  are  authorized  to  deny  all  inter- 
vention of  vital  action.  Although  we  have  demonstrated  that 
all  the  changes  described  heretofore  do  not  have  for  their 
base  any  vital  action  whatsoever,  we  are  not  permitted,  a 
priori,  to  reject  it  as  impossible. 

We  can  have  no  doubt  of  a  certain  vital  action  in  an  or- 
ganic tissue  like  the  dentine,  even  when  it  has  reached  its 
complete  development,  even  if  these  vital  properties  are  but 
little  marked.  We  can  very  well  conceive  that  the  delicate 
fibrils  which,  according  to  Mr.  Tomes's  discovery,  fill  the 
interior  of  the  canals,  and  preside,  in  all  probability,  over  the 
phenomena  of  nutrition  in  the  dentine,  may  become  changed 
by  an  abnormal  excitation  and  thicken  like  cellular  elements 
irritated  or  inflamed,  and  produce  by  division  new  elements, 
as  M.  Xeumann  has  established.  It  is  evident  that  we  must 
admit  changes  of  this  nature  at  the  outset  of  the  diseased 
action,  and  before  the  elements  of  the  leptothrix  have  pene- 
trated into  the  dentinal  canals  and  destroyed  the  fibrils 
which  they  find  there. 

We  have  already  established  that  the  first  changes  mani- 
fest themselves  in  the  dentine,  when  the  enamel  is  carious 
throughout  its  thickness,  though  there  may  not  be  even  the 
slightest  loss  of  substance  at  the  surface  of  the  tooth.  As 
the  leptothrix  is  obliged  to  traverse  the  enamel  to  reach  the 
dentine,  and  as,  in  our  researches,  we  have  found  no  element 
of  leptothrix  in  carious  enamel,  as  long  as  the  caries  has  not 
attacked  the  surface  of  the  dentine,  we  should  expect  to  ob- 
serve, at  this  first  degree  of  the  malady,  isolated  changes  of 
the  dentine  completely  foreign  to  the  action  of  the  leptothrix. 
To  the  naked  eye,  the  dentine  ofters,  at  this  period  of  the 
malady,  the  same  brownish  appearance  as  later  ;  we  remark 
also  that  its  consistency  is  not  sensiblj^  diminished,  except  at 
the  surface,  in  the  vicinity  of  the  enamel,  and  then  only  in  a 
very  tbin  layer;  its  hardness  increasing  rapidly  as  we  go 
towards  the  deeper  portions.  In  most  cases  we  have  found, 
at  this  stage  of  caries,  no  alteration  of  the  canals;  their  dila- 
tation is  normal,  and  they  are  but  rarely  to  be  distinguished 


MICROSCOPIC    CHANGES.  57 

from  the  iiitertubular  substance  by  less  marked  contours. 
In  consequence,  this  dentine  gives  no  reaction  which  indicates 
the  presence  of  leptothrix.  Yet,  exceptionally,  we  have  found 
in  the  superficial  layers  changes  resembling  those  which  we 
have  heretofore  described,  but  thej^  have  been  very  much 
less  developed.  Sometimes  the  canals  were  little  dilated, 
and  their  walls  were  thickened  at  certain  points.  In  the 
small  number  of  cases,  where  we  have  had  the  opportunity 
of  verifying  this  result,  we  have  not  been  able  to  obtain  any 
reaction  capable  of  indicating  the  presence  of  the  fungus  ; 
nevertheless  this  does  not  prove  the  absence  of  the  leptothrix, 
inasmuch  as  at  that  time  we  happened  to  use  too  strong  acids, 
and  so  failed  of  the  reaction,  even  when  the  presence  of  the 
fungus  was  certain.  As  the  changes  existed  only  in  an  ex- 
ceedingly thin  layer  under  the  surface  of  the  dentine,  the 
substance  capable  of  giving  the  reaction  was  present  in  but 
a  very  minute  quantity.  We  think,  nevertheless,  from  the 
identity  of  the  phenomena  which  were  present  in  this  case 
with  those  which  determine  the  introduction  of  the  leptothrix 
into  the  canals,  that  they  depend  upon  the  same  cause.  It 
is  true  that  we  have  not  succeeded  in  proving  the  presence 
of  the  leptothrix  in  the  substance  of  the  enamel,  but  its  sur- 
face was  usually  covered  with  a  granular  mass  of  leptothrix. 
Yet  it  is  possible  that,  on  account  of  the  extreme  minuteness 
of  the  elements  of  the  fungus,  we  have  not  been  able  to  see 
in  the  enamel  the  very  delicate  chinks  through  which  the 
fungus  would  have  to  travel  to  reach  the  dentine,  and  there 
develop  in  a  more  favorable  soil.  This  point,  nevertheless, 
will  agree  with  still  other  observations. 

In  all  cases  it  results  from  this  that  the  introduction  .of 
the  fungus  into  the  dentine  does  not  take  place  during  the 
first  evolution  of  the  caries  ;  at  this  epoch  of  the  malady,  we 
remark  only  the  loss  of  calcareous  salts,  and  the  decomposi- 
tion of  organic  substances,  then  diminution  of  consistency, 
transparent  appearance,  and  brownish  color. 

At  this  stage  the  histologic  examination  permits  us  to 
view,  in  the  structure  of  the  dentine,  no  marked  change. 
We  cannot  say  that  there  are  already  calcareous  deposits  in 

5 


58  INQUIRIES  INTO  DENTAL  CARIES. 

the  canals,  inasmucli  as  we  have  not  given  sufficient  attention 
to  that  point  ;  nevertheless  these  deposits  may  be  early 
formed,  even  at  a  time  when  no  marked  change  of  the  tooth 
is  yet  perceptible. 

From  what  has  just  been  said  we  conclude  that  there  exists, 
up  to  the  present  time,  no  observation  which  authorizes  us 
in  admitting  in  caries  of  the  teeth  an  active  reaction  on  the 
part  of  the  dentine — an  inflammation,  for  example,  ^"e  as- 
sert that  this  caries  comes  not  from  such  causes,  although  it 
is  impossible  to  deny  with  certainty  that  there  exist  slight 
histologic  changes  of  the  dentine,  observed  at  the  beginning 
of  the  malady,  which  are  not  due  to  the  action  oî  leptothrix. 
We  ought  to  add  here  that  the  leptothrix  acts  in  like  manner 
in  the  destruction  of  the  cement  by  caries,  when  it  has  its  seat 
at  the  neck  of  the  tooth. 

We  have  seen,  in  cases  of  this  kind,  the  granular  masses 
of  the  fungus  buried  in  the  chinks  and  excavations  of  the 
cement,  just  as  we  see  them  at  the  surface  of  the  dentine. 
We  have  not  been  able  to  prove  a  particular  change  in  the 
bony  corpuscles  ;  and,  further,  there  is  wanting  every  indi- 
cation which  can  cause  a  suspicion  of  an  inflammatory  state 
of  these  elements.  As  the  number  of  cases  in  which  we  have 
had  an  opportunity  of  examining  caries  of  the  cement  is  but 
small,  we  cannot  draw  from  them  general  conclusions  as  to 
the  absence  of  inflammatory  changes.  Such  changes  would 
not,  however,  be  surprising,  inasmuch  as  the  causes  of  irrita- 
tion of  the  periosteum  of  the  root  of  the  tooth,  as  well  as  the 
production  of  cémentons  substance  of  new  formation,  can  be 
considered  as  ordinary  consequences  of  dental  caries. 


HT. 


CONSIDERATIONS  UPON  THE  PROGRESS  AND 
SY3IPT0MS  OF  CARIES  OF  THE  TEETH. 

Having  described  the  anatomo-pathologic  changes  which 
take  place  in  caries  of  the  enamel,  and  of  the  dentine,  we 
will  now  proceed  to  define  in  a  few  words  the  variations  of 
the  progress,  symptoms,  cSrc,  of  this  attection,  and  to  show 
that  these  variations  are  perfectly  explained  by  the  results 
of  our  researches. 

First,  the  different  varieties  of  the  beginning  of  caries  have 
received  a  considerable  number  of  denominations,  but  we  are 
obliged  to  confess  that  we  have  not  found  essential  ditferences, 
and  we  think  they  can  all  be  explained  by  a  greater  or  less 
duration,  by  the  variable  resistance  of  the  dental  tissue,  and 
by  the  lesions,  more  or  less  extensive,  which  exist  from  the 
first  in  the  enamel.  AVe  have  already  remarked  that  there 
can  be  distinguished  a  form  of  caries  \ohich  is  propagated  more 
towards  the  surface.,  and  another  whose  character  is  to  burrow 
into  the  deeper  portions  ;  these  two  forms  do  not  ofter  any 
other  essential  difierence.  The  caries  called  d.ry  is,  properly 
speaking,  only  the  first  degree  of  the  work  of  the  malady, 
when  the  dentine  is  as  yet  but  incompletely  decalcified, 
when  no  element  of  leptotJirix  has  yet  penetrated  there,  and 
no  change  has  manifested  itself  at  its  surface.  Then  the 
enamel  as  well  as  the  dentine  is  transformed  by  mechanical 
action  into  a  rather  fine,  hard,  pulverulent  mass  ;  while  in 
the  so-called  filn*illary  caries,  the  suljstance  of  the  dentine, 
much  softer,  and  as  it  were  cartilaginous,  appears  to  be  com- 
posed of  very  fine  filaments.  This  filamentous  texture  de- 
pends upon  the  great  dilatation  of  the  dentinal  canals. 

The  tooth  will  remain  in  the  state  of  dry  caries  the  longer 


60  INQUIRIES  INTO  DENTAL  CARIES. 

in  proportion  as  it  shall  offer  by  its  density  greater  resistance 
to  the  invasion  of  tlie  malady,  so  that  the  fibrillary  or  humid 
caries  may  perhaps  at  times  never  become  established  there. 
The  carious  substance  is  at  such  times  marked  by  a  very 
dark  color. 

When  the  caries,  on  the  other  hand,  makes  rapid  progress 
in  a  tooth  of  little  resistance,  it  may  happen  that  the  destruc- 
tion follows  promptly  the  preparatory  changes.  In  this  case 
the  dry  caries  may  pass  wholly  unperceived,  or  be  observed 
but  a  short  time;  the  brown  discoloration  wdll  also  be  but 
slight.  The  enamel  and  the  dentine  are  in  such  cases  changed 
into  a  soft,  whitish,  pulpy  mass,  and  the  tooth  promptly 
reaches  its  total  destruction. 

There  is  distinguished  a  form  of  caries  which  attacks  the 
necks  of  the  teeth.  It  attacks  almost  always,  and  at  the 
same  time,  all  the  teeth  in  front,  and  more  particularly  those 
of  the  lower  jaw.  It  forms  at  the  necks  of  the  teeth  a  smooth, 
gutter-like  furrow.  This  is  often  so  marked  and  so  polished 
that  one  might  say  it  had  been  made  wdth  a  file.  Generally 
it  is  only  the  incisors  and  canines  which  are  attacked  ;  yet, 
sometimes,  this  caries  extends  to  all  the  teeth  of  a  jaw,  but 
the  incisors  and  canines  are  alwa3^s  more  strongly  attacked 
than  the  molars. 

A'^ery  often  the  gutters  which  exist  across  the  necks  of  the 
teeth  are  of  a  normal  white  color,  and  wholly  smooth,  as  if 
'they  had  been  polished.  In  other  cases  the  surfiice  of  the 
gutters  is  smooth,  it  is  true,  but  has  the  brownish  coloring 
of  caries.  We  have  had  opportunities  of  examining  anatomi- 
cally two  teeth  of  this  kind.  Upon  a  section  made  longitu- 
dinally we  have  observed  that,  proceeding  from  the  gutter, 
there  was  only  a  feeble  trace  of  a  brownish  cone  looking 
towards  the  pulp- cavity,  for  this  reason,  the  changes  which 
precede  the  caries  of  the  dentine  extended  to  but  a  slight 
depth,  and  were  not  marked.  The  density  of  the  dentine 
was  but  little  less  than  normal;  there  was,  just  below  the 
surface,  a  slightly  marked  brownish  shade.  Under  the 
microscope  we  observed  in  this  superficial  layer,  as  usual, 
the  dentinal  canals  filled  with  Icptothrix.     The  surface  was 


PROGRESS    AND    SYMPTOMS    OF    CARIES.  61 

smooth,  and  it  was  impossible  to  find  there  a  laj-er  evidently 
softened.  The  enamel  had  been  wanting  for  a  long  tune  in 
the  greater  part  of  the  gutter;  but, on  the  side  of  one  tooth, 
we  observed  that  the  gutter,  in  becoming  of  less  and  less 
depth,  extended  for  a  short  space  across  a  bit  of  carious 
enamel  of  a  brownish  color.  Upon  the  other  tooth  the  gutter 
stopped  suddenly  with  well-defined  outlines  on  every  side. 
In  a  vertical  section  it  presented  the  form  of  a  triangle 
with  its  base  turned  outwards,  and  its  vertex  towards  the 
cavity  of  the  pulp.  On  the  lower  side  of  this  triangle  there 
appeared  a  brownish  cone  directed  towards  the  pulp-cavity. 
Upon  the  interior  surface  of  the  pulp-cavity,  at  the  place 
corresponding  to  the  gutter  without,  there  was  found  at  the 
extremity  of  the  brownish  cone  a  projection  formed  of  den- 
tinal substance,  of  new  formation,  which  had  penetrated  the 
pulp-cavity  to  a  considerable  depth. 

In  this  observation  it  was  evident  that  the  caries  was  of  a 
very  slow  progress,  but  had,  notwithstanding,  all  the  essen- 
tial characters  of  this  aftection.  The  surface  changes  took 
place  slowly,  and  the  afiected  portions  were  with  proportion- 
ate slowness  involved,  while  the  surface  was  kept  constantly 
smooth  by  friction  with  the  brush.  The  polish  of  the  surface 
is  sometimes  so  great  that  it  might  be  supposed  to  be  efiected 
by  friction  against  a  'tooth  ;  yet  this  is  impossible  for  the 
neck,  in  consequence  of  the  position  of  the  teeth.  To  exphiin, 
therefore,  the  polish  of  the  surface,  we  can  invoke  only  the 
action  of  the  brush,  and  the  friction  of  the  lips  and  of  the 
tongue.  It  remains,  nevertheless,  to  inquire  if  these  gutters, 
with  so  highly  polished  surfaces,  must  be  considered  as  sta- 
tionary, as  most  authors  think.  There  are  cases  where  the 
teeth  always  preserve  a  white  and  polished  surface,  and  in 
which,  nevertheless,  the  aftection  makes  incessant  progress, 
but  in  a  manner  so  slow  that  years  often  roll  by  before  only 
a  thin  w^all  separates  the  caries  from  the  pulp-cavity.  The 
aftection,  arrived  at  this  stage,  ends  by  exposing  the  dental 
pulp,  and  the  tooth  is  often  broken  at  this  point.  Doubtless 
the  progress  of  the  caries  can  be  retarded  by  dentine  of  new 
formation  deposited  upon  the  interior  surface  of  the  dental 


62  INQUIRIES    INTO    DENTAL    CARIES. 

canal,  otherwise  we  should  see,  particularly  in  the  incisors, 
this  thin  wall  of  dentine  niucli  sooner  destroyed,  and  the 
canal  opened.  If  we  consider  isolated  facts  of  this  kind,  we 
feel  little  disposed  to  take  these  pljenomena  for  symptoms  of 
veritable  caries  ;  but  by  analogy  with  other  facts,  where  the 
nature  of  the  caries  is  shown,  we  are  compelled  to  admit 
equally  for  these  exceptional  cases  that  we  have  to  do  with 
a  caries  whose  progress  is  very  slow,  which,  for  a  time,  may 
be  really  stationary,  and  afterwards  take  on  new  life  under 
the  influence  of  a  favorable  cause. 

J^evertheless,  it  should  not  be  asserted  that  all  cases  of 
caries  of  the  neck  have  this  slow  evolution.  There  are  cases 
where  its  march  is  absolutely  the  same  as  in  ordinary  caries. 
It  would  appear  that  the  cause  of  this  caries  is  the  denuda- 
tion of  the  neck  by  the  absence  of  the  gum.  Upon  the 
slightly  rough  surface  of  the  cement  fermenting  mucus  and 
fragments  of  food  are  more  easily  deposited,  and  these  same 
agents  fixed  bet^^•een  the  gums  and  the  neck  of  the  tooth  are 
less  easily  removed.  It  ma}'  then  happen  in  cases  where  the 
injurious  causes  are  weak,  or  the  teeth  of  a  special  hardness, 
that  it  is  just  the  necks  of  the  teeth  which  are  more  likely 
to  be  aifected. 

In  some  very  rare  cases  we  notice  a  peculiar  wasting  of 
the  incisor  and  canine  teeth,  attacking  as  well  the  enamel 
as  the  dentine,  and  which  shows  its  greatest  intensity  upon 
the  centrals.  There,  when  the  mouth  is  closed,  the  cutting 
edges  of  the  teeth  form  arcs  of  opposite  concavity,  and  show 
a  longitudinal  interval  between  them.  For  want  of  sufficient 
observations  it  is  not  possible  for  us  to  say  if  these  morbid 
phenomena  belong  or  not  to  caries.  The  form  of  the  wasting 
does  not  permit  us  to  attribute  it  to  mechanical  action. 

Stationary  Caries. 

In  what  is  called  stationary  caries  reference  is  often  had 
to  dry  caries  onlj'  whose  progress  is  very  slow,  or  is  distin- 
guished by  longer  or  shoi-tcr  times  of  rest.  There  are,  never- 
theless, cases  where  the  disease  is  really  stationarj^,  but  this 


STATIONARY    CARIES.  63 

can  be  only  where  the  teeth  possess  great  power  of  resistance, 
and  when  the  caries  has  a  very  slow  progress.  It  is,  not- 
withstanding, necessary  to  distinguish  the  difterent  stages  of 
caries  in  which  it  becomes  stationary. 

In  the  dry  caries,  when  there  does  not  yet  exist  any  change 
at  the  surface,  it  seems  that  the  caries  may  easily  become 
stationary.  This  is  readily  understood,  inasmuch  as  it  is 
enough  to  suppress  the  action  of  acids,  the  tooth  having  still 
sufficient  hardness,  and  being  still  free  from  all  attack  of 
leptothrix.  Yet  it  may  sometimes  happen,  when  the  caries 
has  reached  a  stage  where  the  greater  part  of  the  enamel  and 
a  superficial  layer  of  dentine  are  destroyed,  that  the  n:ialady 
is  stopped.  This  is  seen  in  molar  teeth  whose  depressions 
are  incompletely  provided  with  enamel,  and  which  show 
defects  upon  their  surfaces.  In  these  cases  we  see  ordinarily, 
from  the  beginning  of  the  malady,  a  great  part  of  the  surface 
of  the  enamel  attacked  by  caries  ;  the  dentine  may  be  still 
sound,  and  ofier  great  resistance.  While  the  enamel  is  so 
rapidly  destroyed,  as  far  as  the  surface  of  the  dentine,  the 
softening  of  this  latter,  and  the  loss  of  its  calcareous  salts, 
are  carried  to  but  a  slight  depth.  The  relation  between  the 
rapidity  of  the  destruction  of  the  enamel  and  that  of  the 
dentine  is  then,  in  such  cases,  the  inverse  of  that  which 
exists  in  the  normal  state.  When  the  caries  has  attacked 
the  surface  of  the  dentine,  which,  in  consequence  of  the 
defective  structure  of  the  enamel,  takes  place  at  once  over 
the  greater  part  of  it,  the  dentine  is  but  slightly  softened, 
and  to  but  a  very  little  depth.  The  most  superficial  layers 
of  the  dentine  are  removed,  and  by  friction  upon  the  smooth 
surface  the  work  of  the  caries  is  arrested,  the  surface  becomes 
more  and  more  polished,  and  ofters  less  opportunity  for  the 
accumulations  of  mucus  and  particles  of  food  undergoing 
acid  fermentation  ;  finally  there  results  from  all  this  a  sta- 
tionary condition.  The  tooth  presents  a  polished  surface, 
but  of  a  brownish  color,  as  if  to  attest  that  the  substance  at 
the  surface  has  been  the  seat  of  caries. 
.  The  considerations  presented  by  Mr.  Tomes  and  M.  Magitot 
upon  the  cause  which  determines  the   stationary  state  of 


64  INQUIRIES  INTO  DENTAL  CARIES. 

caries  are  founded  upon  the  presence  of  calcareous  deposits 
in  the  minute  dentinal  canals.  As  we  explain  the  matter, 
the  calcareous  salts  deposited  in  the  canals  should  have  the 
ability  to  arrest  the  work  of  the  caries,  and  give  the  already 
softened  dentine  a  greater  density.  Yet,  as  the  formation 
of  these  calcareous  deposits  cannot  be  attributed  to  a  vital 
action,  we  are  led  to  believe  that  they  are  secondary,  and 
that  they  become  abundant  only  when,  from  some  cause,  the 
action  of  the  acids  has  ceased  ;  then  the  calcareous  salts 
which  existed  in  a  state  of  solution  are  precipitated.  Neither 
do  we  believe  that  the  dentine  can  become  harder  in  station- 
ary caries,  excepting,  perhaps,  the  surface,  where  mechanical 
means,  such  as  friction  or  pressure,  may  produce  a  slight 
condensation.  To  explain  the  facts  it  is  sufficient  to  admit 
that  the  dentine  had  not  yet  lost  its  normal  hardness,  or  at 
least  had  lost  it  in  but  a  veiy  slight  degree. 

In  these  cases  of  slow  and  stationarj-  caries  we  also  very 
often  find  the  formation  oi  new  dentine  at  the  inner  surface 
of  the  dental  cavity.  We  can  explain  this  phenomenon  by 
the  fact  of  a  long  irritation  which  the  pathological  action  of 
the  caries  exercises  upon  the  pulp.  It  contributes  very  much 
in  the  given  circumstances  to  the  preservation  of  the  tooth. 

When  the  caries  is  farther  advanced  there  are  formed  in 
the  dentine  cavities,  generally  rounded,  which  communicate 
with  the  surface  of  the  tooth  by  a  greater  or  less  opening; 
or  the  morbid  action  occasions  loss  of  substance  more  exten- 
sive, and  without  depth.  Little  by  little  the  disorganization 
reaches  the  cavity  of  the  pulp;  this  is  exposed  at  some  point, 
and  very  often,  in  consequence  of  its  irritation,  successive  in- 
flammations are  excited  which  end  in  its  destruction. 

It  has  been  observed  that  when  the  pulp  is  destroyed  the 
caries  proceeds  much  more  rapidly,  and  from  this  fact  the 
proof  has  been  sought  to  be  drawn  that,  as  long  as  the  pulp 
retains  its  vital  properties,  it  contributes  to  the  preservation 
of  the  tooth  ;  while  the  contrary  happens  immediately  upon 
its  ceasing  to  exist.  But  the  more  rapid  progress  of  the 
caries  after  the  destruction  of  the  pulp  is  explained  by  the 
fact  of  there  then  being  a  much  greater  surface  exposed  to 


STATIONARY    CARIES.  65 

its  action,  inasmucli  as  now  the  destruction  works  in  every 
direction,  not  only  from  the  ancient  cavity,  but  from  the 
pulp-cavity  which  corresponds  to  it.  It  is  not  necessary, 
therefore,  to  attribute  to  the  pulp  a  conservatory  action  for 
the  tooth,  excepting,  indeed,  the  dentine  of  new  formation 
which  it  builds  up,  and  which  really  protects  the  tooth 

While  the  caries  continues  its  ravages  the  walls  of  the 
cavity,  which  are  formed  by  the  sides  of  the  crown,  break 
down,  so  that  the  tooth  is  destroyed  down  to  the  level  of  the 
roots.  Starting  from  this  point  we  observe,  in  most  cases, 
the  caries  take  up  anew  a  slower  action,  such  that  the  roots 
which  remain  may  be  preserved  for  a  long  time  in  their 
alveoli.  It  may  be  that  the  friction  which  must  be  con- 
tinually acting  may  be  the  cause  of  this,  in  part  at  least, 
opposing  itself  to  the  progress  of  the  disease  by  oiiering  a 
more  polished  surface.  Another  reason  which  seems  to  us 
still  more  important  is  that  which  is  derived  from  the  direc- 
tion of  the  dentinal  canals.  These  proceed  at  the  surface  of 
the  teeth  more  or  less  vertically  from  the  pulp  towards  the 
exterior,  so  that,  taking  this  part  for  its  point  of  departure, 
the  caries  is  able  to  propagate  itself  easily  to  the  interior, 
following  the  direction  of  the  canals. 

At  the  commencement  of  the  surface  of  the  roots,  on  the 
contrary,  these  little  canals  have  a  direction  oblique,  and 
parallel  to  this  surface.  Then,  when  the  tooth  is  decayed 
away  np  to  the  root,  the  direction  of  the  canals  no  longer 
favors  the  introduction  of  the  acids  and  the  elements  oîle.p- 
tothrix  into  the  deeper  parts.  This  explains  the  slower  prog- 
ress of  the  caries  when  it  reaches  this  point.  In  the  same 
way  may  be  explained  the  fact  that  caries  is  never  seen  to 
be  developed  around  the  walls  of  a  canal  artificially  pierced 
at  the  neck  of  a  tooth  (Hulihan's  operation);  the  little  den- 
tinal canals,  following  a  direction  parallel  to  that  of  the  walls 
of  the  artificial  canal,  also  in  this  case,  do  not  permit  the  in- 
troduction of  injurious  elements. 

The  sensibility  of  carious  dentine  may  be  occasioned  by  a 
greater  irritability  of  the  pulp.     Yet  it  is  difficult  to  explain 


6Q  INQUIRIES  INTO  DENTAL  CARIES. 

why  the  superficial  layers  of  the  dentine  are  very  often  more 
sensitive  than  those  which  are  deeper. 

To  Mr.  Tomes  this  consideration  appeared  to  have  great 
weight.  AVe  observe,  in  fact,  that  quite  frequently  the  least 
touch  causes  the  acutest  pain  in  the  carious  dentine,  at  a 
stage  when  the  cavity  of  the  pulp  is  still  far  from  being 
reached.  At  such  times  the  removal  of  the  superficial  lay- 
ers of  carious  dentine  occasions  excessive  pain  ;  but  as  soon 
as  this  layer  is  removed  the  sensibility  of  the  subsequent 
layers  is  seen  to  be  very  much  less.  The  greatest  sensibility 
ordinarily  exists  at  the  extremity  between  the  enamel  and 
the  dentine  We  especially  remark  this  in  the  incisors  at 
their  acute  angle,  where  the  anterior  and  posterior  surfaces 
come  together.  Mr.  Tomes  has  concluded  from  these  facts 
that  the  dentine  itself  is  endowed  with  sensibility,  and  that 
this  is  not  due,  at  least  exclusively,  to  contact  with  the 
pulp.  He  believes  that  this  sensibility  is  occasioned  by  the 
soft  fibrils  which  he  has  discovered  in  the  interior  of  the 
dentinal  canaliculi;  he  does  not  consider  them  as  true  ner- 
vous fibrils,  but  thinks  they  may  be  agents  of  sensibility. 
This  opinion  cannot  be  reconciled  with  the  actual  state  of 
physiology.  Either  the  fibrils  of  Mr.  Tomes  are  truly  en- 
dowed with  sensibility,  and  are  therefore  true  nervous  fibrils, 
or  they  have  no  nervous  nature,  and  cannot  transmit  sensi- 
bility, inasmuch  as  this  function  belongs  essentially  to  the 
nature  of  nerves.  But  every  consideration  is  opposed  to 
considering  them  as  nerve  fibrils,  and  their  origin  above  all. 
They  are  prolongations  of  the  cells  of  the  dentine,  a  fact 
which  establishes  their  analogy  with  the  ramifications  of 
osteoplasts,  or  the  plasmatic  cells  of  the  cornea.  Xerves 
have  not  been  found  in  the  dentine,  and,  in  the  absence  of 
all  anatomical  proof,  we  must  not  be  too  hasty  to  attribute 
sensibility-  to  it.  Assuredly  the  facts  we  have  mentioned 
would  be  easily  explained  if  the  dentine  had  a  sensibility  of 
its  own,  because  then  certain  diseased  parts  would  acquire 
more  sensibility  than  others.  This  sensibility  may  be  ex- 
plained, perhaps,  by  a  certain  direction  of  the  canaliculi,  or 
at  least  by  a  more  considerable  expansion  at   the  surface, 


STATIONARY    CARIES.  67 

which  may  be  more  accessible  to  mechanical  actions,  and 
may  transmit  them  to  the  pulp.  Experiments,  whose  object 
should  be  to  inquire  into  the  rapidity  with  which  the  slight- 
est contacts  are  followed  by  pain,  would  perhaps  give  new 
enlightenment  upon  the  subject.  But  until  nerves  are  dis- 
covered in  the  dentine,  and  clinical  experiment  has  furnished 
us  with  authentic  facts,  we  shall  feel  more  inclined  to  at- 
tribute the  sensibility  to  the  irritated  pulp  than  to  the  den- 
tine itself. 


IV. 

CAUSES  OF  CARIES. 

From  what  has  been  said  it  results  that  two  principal  phe- 
nomena manifest  themselves  in  the  formation  of  dental  caries, 
viz.,  the  action  of  acids ^  and  ihejrapid  development  of  a  parasitic 
plant,  the  leptothrix  huccalis.  In  the  following  chapter  we 
shall  have  to  examine  more  in  detail  the  mode  in  which  these 
agents  proceed  and  the  conditions  of  their  appearing. 

The  action  of  injurious  elements  is  favored  by  predisposing 
circumstances  which  consist  mainl}^  in  the  structure  and  in 
the  incomplete  development  of  the  dental  tissues.  The  in- 
fluence exercised  upon  the  formation  of  caries  by  constitu- 
tional anomalies  and  by  certain  coexisting  maladies  may  be 
referred  principally  to  two  circumstances  :  first,  we  very 
often  remark  troubles  in  the  development  of  the  teeth 
during  the  existence  of  certain  maladies,  or  when  there  exist 
constitutional  anomalies.  The  tissue  of  the  teeth  is,  in  such 
cases,  incompletely  formed,  and  unsuited  to  resist  the  action 
of  injurious  agents  ;  then  local  conditions  of  the  buccal  cavity 
may  favor  the  formation  of  acids,  as  well  as  of  the  para- 
sitic plant,  the  leptothrix.  Likewise  many  maladies  of_the 
mouth  and  certain  states  of  the  stomach  cause  to  arise  in  the 
buccal  cavity  an  abnormal  work  of  fermentation  which  is 
accompanied  by  a  more  abundant  formation  of  acids,  and 
favors  the  production  of  the  fungi.  The  progress  of  the 
caries  is  equally  favored  w^hen,  in  consequence  of  sickness  or 
from  any  other  cause,  the  saliva  is  secreted  in  too  small  a 
quantity,  thus  preventing  the  neutralizing  or  diluting  of  the 
acids. 


CAUSES    OF    CARIES.  69 


I.  PREDisposma  Causes  of  Caries  due  to  the  Form  and 
Structure  of  the  Teeth. 

We  have  first  to  examine  the  incomplete  development  of 
the  dental  tissues,  above  all  of  the  enamel  and  the  dentine, 
which  is  a  predisposing  cause  of  the  greatest  importance. 

In  congenital  anomalies  of  the  enamel  we  may  distinguish 
anomalies  quantitative  and  anomalies  qualitative. 

The  quantitative  anomalies  are  manifested  under  very 
diverse  forms.  The  surface  of  the  enamel  is  irregular,  pre- 
sents inequalities  and  depressions  more  or  less  developed,  and 
which  may  be  few  in  number,  or  scattered  over  the  whole 
surface  of  the  crown.  These  teeth  are  sometimes  designated 
as  "honeycombed"  teeth,  from  their  resemblance  to  that 
article.  In  other  cases  we  see  the  cutting  edge  of  the  incisors 
notched  or  toothed,  and  sometimes  of  a  conical  shape,  both 
which  forms  are  caused  by  deficiency  of  the  enamel  ;  or  the 
teeth  present  parallel  furrows  crossing  them  horizontally. 

The  name  of  erosion  is  given  to  those  lesions  which  show 
themselves  at  once  upon  several  teeth,  and  yet  they  are  but 
incomplete  developments  of  the  enamel  which  have  of  erosion 
only  the  form.  Finally,  the  enamel  is  sometimes  complerely 
wanting  upon  a  greater  or  less  extent  of  the  crown. 

The  anomalies  just  described  must  be  onlj^  too  favorable 
to  the  establishment  of  caries,  inasmuch  as  the  agents  of  an 
injurious  nature  deposited  in  the  cavities  and  irregularities 
of  the  tooth  can  extend  their  action  without  obstacle,  and 
much  better  than  on  a  polished  surface.  The  fissures  of  the 
enamel  occasioned  by  sudden  changes  of  temperature  may 
exercise  the  same  influence.  Doubts  have  been  raised  upon 
the  possibility  of  seeing  fissures  of  the  enamel  caused  by 
changes  of  temperature,  but  these  fissures  are  sufificiently 
frequent.  In  many  cases  the  enamel  of  the  greater  number 
of  the  teeth,  and  sometimes  even  of  all,  is  seen  covered  with 
chinks  in  every  direction.  They  are  most  frequently  caused 
by  sudden  changes  of  temperature,  but  sometimes  are  due  to 
a  traumatic  action.     We  have  convinced  ourselves  of  the 


70  INQUIRIES    INTO    DENTAL    CARIES. 

direct  influence  of  the  first  of  these  causes  by  plunging  the 
teeth  alternately  into  hot  liquids  of  a  temperature  about 
equal  to  that  of  hot  meats,  and  then  into  iced  water.  It 
seems,  nevertheless,  that  these  fissures  have  less  influence 
than  the  defects  of  the  enamel  upon  the  formation  of  caries, 
supposing  that  it  possesses  a  normal  density  and  hardness. 
"VVe  find,  in  fact,  teeth  whose  enamel  shows  fissures  in  every 
direction,  and  which,  after  a  long  time,  have  not  been  at- 
tacked by  caries.  But  if  the  fissures  appear  in  teeth  whose 
enamel  is  primitively  less  resistant,  it  is  clear  that  they  oflfer 
greater  oj^portunity  to  the  action  of  injurious  agents. 

The  qualitative  anomalies  which  depend  upon  an  incom- 
plete development  of  the  enamel  often  coincide  with  the 
quantitative;  they  may,  however,  exist  separatel3\  They 
are  distinguished,  in  general,  by  a  less  hardness  and  by  an 
opaque  appearance  of  the  enamel.  Mr.  Tomes  distinguishes 
two  kinds  :  in  one  the  enamel  presents  a  brownish  and  dead 
color,  showing  itself  more  particularly  upon  teeth  which  are 
marked,  as  has  been  said  above,  with  congenital  fissures  and 
depressions,  and  the  excavations  are  marked  in  general  by  a 
somewhat  darker  color.  The  other  kind  presents  itself  under 
the  form  of  white  spots  of  greater  or  less  extent. 

In  the  first  kind  were  discovered  by  Mr.  Tomes  deposits 
of  minute  calcareous  o-ranulations  in  the  interior  of  the 
enamel  prisms,  at  the  same  time  that  the  peripheric  layers 
of  the  prisms  were  impregnated  with  calcareous  salts  in  a 
homogeneous  manner.  We  speak  here  of  an  insufiiicient 
quantity  of  calcareous  salts  in  the  central  portions  of  the 
enamel  prisms,  a  circumstance  which  is  but  an  exaggeration 
of  the  physiologic  condition.  In  fact,  according  to  Mr. 
Tomes,  the  central  portions  of  the  prisms  in  the  normal  state 
become  impregnated  more  slowly  with  calcareous  salts,  and 
are  therefore  more  promptly  deprived  of  them  by  weak  acids 
than  are  the  layers  of  the  periphery.  In  some  cases  ]\Ir. 
Tomes  observed  minute  excavations  in  the  interior  of  the 
prisms  of  this  incompletely  developed  enamel. 

In  the  congenital  white  patches  of  the  enamel  i\Ir.  Tomes 
found  the  fibrillary  structure  of  this  tissue  more  or  less  well 


CAUSES    OF    CARIES.  71 

preserved,  inasmuch  as  the  prisms  are  less  stronglj'  united  to 
one  another,  while  this  structure  is  lost  ordinarily  by  the 
fusion  of  the  peripheric  layers  of  the  prisms  of  the  enamel. 

We  have  had  very  little  opportunity  of  examining  these 
anomalies  ;  our  experience  being  confined  to  two  cases  of 
congenital  patches  upon  the  enamel.  But  these  two  teeth 
presented  in  the  middle  of  the  patches  a  dark  brown  color, 
like  the  sign  of  commencing  caries  ;  yet  the  sharp  contour 
of  the  spots  and  the  well-marked  white  color  left  nothing  in 
doubt.  They  were  really  congenital  patches  which  were 
commencing  to  be  affected  b}'^  caries. 

The  consistency  of  the  enamel  had  considerably  diminished, 
the  lightest  pressure  sufBcing  to  reduce  to  powder  the  de- 
tached fragments.  Very  rarely  a  column  was  seen  to  separate 
from  the  neighboring  columns,  and  then  only  for  a  small  ex- 
tent; the  contours  of  the  prisms  being  very  distinct,  w^iile 
the  oblique  striœ  were  so  in  only  one  of  the  two  cases. 

The  prisms  of  the  enamel  were  strongly  enough  united  in 
the  two  cases,  and  their  cohesion  was  not  diminished,  as  Mr. 
Tomes  has  asserted.  In  view  of  the  paucity  of  observations, 
we  will  not  venture  to  draw  from  these  facts  other  conclu- 
sions, still  less  as  it  is  impossible  to  establish  with  certainty 
what  ought  to  be  placed  to  the  account  of  caries  and  what 
to  congenital  alterations  of  structure. 

As  for  the  rest,  the  jiredisposition  to  caries  in  these  con- 
genital anomalies  of  the  enamel  is  sufRcientlj^  proved  by  the 
lesser  hardness  of  the  parts. 

It  is  remarked  also  that  there  is  often  a  coincidence  be- 
tween these  anomalies  of  structure  of  the  enamel  and  an 
incomplete  development  of  the  dentine,  3'et  the  anomalies  of 
structure  show"  themselves  less  often  in  the  dentine  than  in 
the  enamel.  In  most  cases  there  exists  in  the  dentine  a 
great  number  of  interglobular  spaces  ;  according  to  the  dis- 
covery of  M.  Magitot,  these  are  seen  sometimes  in  several 
layers  parallel  to  the  surface  of  the  dentine,  and  spaced  in  a 
pretty  uniform  manner.  This  anomaly  has  for  cause  a  defect 
of  development  which,  in  its  turn,  hinders  the  calcareous 


72  INQUIRIES    INTO    DENTAL    CARIES. 

salts  from  penetrating  certain  parts  of  the  tooth  in  sufficient 
quantit}'. 

We  meet  this  anomaly  more  particularly  in  cases  of  those 
more  considerable  defects  of  the  enamel  which  go  by  the 
name  of  erosion  ;  while  there,  where  the  enamel  presents 
cracks,  holes,  and  furrows,  such  as  we  see  in  " honeycombed" 
teeth,  the  dentine  very  often  offers  a  great  resistance. 

The  causes  of  the  trouble  in  the  development  of  the  tissues 
of  the  tooth,  as  well  of  the  enamel  as  of  the  dentine,  are  of 
several  kinds.  Some  local  affections  of  the  mouth  and  gen- 
eral maladies  of  very  different  nature  may  cause  perturbations 
i n  the  development  of  the  teeth.  Mr.  Hutchinson  has  marked, 
as  a  very  frequent  cause  of  this  anomaly,  constitutional 
syphilis,  j^evertheless,  it  is  well  proved  that  many  other 
maladies  occasion  the  same  phenomena.  Setting  aside  the 
greater  defects  of  development,  the  dental  tissues  present,  in 
their  hardness  and  chemical  composition,  varieties  which 
render  them  more  or  less  fitted  to  resist  external  influences- 
This  is  easil}'  seen  by  the  difierence  in  the  color  of  the  teeth, 
and  by  the  appearance  they  present,  and  it  is  from  these 
different  properties  that  classifications  have  been  made. 

Considering  the  lack  of  positive  observations  upon  the 
subject  in  question,  we  can  give  only  our  suppositions  upon 
the  causes  of  the  varieties  of  color  and  of  appearance  in 
teeth.  The  relative  quantity  of  organic  substances,  and  of 
substances  inorganic,  seems  to  be  of  especial  importance.  A 
priori^  the  existence  of  these  varieties  of  enamel  as  well  as  of 
dentine  could  not  be  doubted,  and  analysis  has  confirmed  the 
supposition.  Xevertheless,  the  teeth  offer  us  no  physical 
indication  by  which  we  are  enabled  to  recognize  with  cer- 
tainty one  or  other  variety  in  their  chemical  composition. 
The  teeth  of  different  individuals  offer  in  general  aspects 
sufficiently  various,  but  we  may  say  that  they  diverge  in 
two  different  directions  from  that  which  we  have  taken  as 
a  standard,  viz.,  a  white  color  combined  with  a  moderate 
transparency  of  the  enamel.  The  teeth  are  either  much 
bluer  and  more  transparent  than  the  average,  or  else  yellow 
and  more  opaque.     There  is  among  them  every  variety  of 


CAUSES    OF    CARIES.  73 

different  type.  The  blue  and  transparent  teeth  have  little 
power  of  resistance,  while  those  of  a  yelloAv  and  much  less 
agreeable  tinge  are  distinguished  by  their  very  great  resist- 
ance to  the  attacks  of  caries. 

It  is  generally  believed  that  the  less  power  of  resistance  a 
tooth  has  to  caries  the  more  organic  substance  it  should 
possess  in  proportion  to  the  inorganic;  and,  in  the  contrary 
case,  that  the  inorganic  substances  should  predominate.  A 
jmori,  this  theory  cannot  be  admitted.  In  the  experiments 
which  we  give  farther  on  concerning  the  action  of  acids  upon 
the  teeth,  it  has  been  demonstrated  that  the  enamel  is  always 
the  seat  of  the  first  changes,  while  the  dentine  and  the  cement 
are  attacked  only  after  some  time.  It  is  .easy  to  conceive 
that  a  slight  diminution  of  the  calcareous  salts  may  become 
very  sensible  in  the  enamel,  because  the  quantity  of  organic 
substance  is  too  weak  to  preserve  the  form  and  consistence 
of  the  tissue  after  the  subtraction  of  a  portion  of  the  salts; 
the  dentine,  on  the  contrary,  preserves,  even  after  the  total 
loss  of  the  calcareous  salts,  its  former"  shape,  and  presents  a 
consistency  not  unlike  that  of  cartilage.  Yet  are  we  not 
permitted  to  draw  from  this  the  conclusion  that  the  richer 
the  dentine  or  the  enamel  are  in  organic  matters,  the  more 
capable  are  they  of  resisting  the  attacks  of  caries,  inasmuch 
as  many  other  causes  may  act  at  the  same  time.  In  spite  of 
this  it  appears  to  us  probable  that  the  bluish  and  transparent 
teeth  are  relatively  less  well  provided  with  organic  matters, 
especially  in  the  enamel,  than  the  yellow  teeth,  which  resist 
better. 

Are  there  still  other  anomalies  of  composition,  especially 
in  what  concerns  the  quantity  of  the  ditierent  salts  which 
influence  the  predisposition  to  caries?  We  as  yet  know 
nothing  positive  thereupon.  As  for  the  enamel,  the  most 
recent  analyses  of  M.  Hoppe  have  shoAvn  that  the  relative 
quantities  of  phosphate  and  carbonate  of  lime  are  sufficiently 
constant  in  animals  belonging  to  the  most  varied  species. 
There  are,  on  the  average,  three  elementary  molecules  of 
phosphate  of  lime  for  one  of  lime  united  with  chlorine,  fluo- 

6 


74  INQUIRIES    INTO    DENTAL    CARIES. 

rice,  or  carbonic  acid.*  According  to  this,  at  least  as  regards 
the  enamel,  it  will  be  less  probable  that  variations  of  the 
proportions  of  the  different  salts  will  ever  be  proved. 

It  appears  that  there  exist,  also,  in  the  physical  hardness 
of  teeth  difierences  which  may  natnrally  have  a  great  impor- 
tance in  the  predisposition  to  caries. 

II.  Influence  of  Acids  upon  the  Production  of  Caries 
OF  THE  Teeth. 

No  one  at  this  day  can  refuse  to  believe  in  the  necessity  of 
the  action  of  acids  to  occasion  caries  of  the  t^eth.  The  salts 
contained  in  the  enamel  and  in  the  dentine  cannot  be  dis- 
solved in  water;  acids  are  indispensable  to  work  their  solu- 
tion. But  it  is  not  at  all  necessary  to  employ  strong  acids 
for  the  purpose  of  separating  the  carbonic,  or  even  the  phos- 
phoric acid  from  the  lime  with  which  they  are  combined. 
The  calcareous  salts  of  the  tooth,  as  well  the  carbonate  as  the 
phosphate  of  lime,  are  dissolved  in  some  acid,  even  in  water 
which  contains  carbonic  acid,  as  they  are  changed  into  acid 
salts  which  water  dissolves  with  sufficient  ease.  In  fact  it 
is  acknowledged  that  the  surface  of  carious  teeth  very  often 
presents  an  acid  reaction.  This  reaction  is  constant  upon 
the  contents  of  carious  cavities  in  which  the  disease  is  in 
active  progress.  Mr.  Spence  Bate  cites  an  observation  from 
which  we  might  draw  the  conclusion  that  pure  water  can 
dissolve  the  teeth. 

A  lady  had  two  cases  of  artificial  teeth  ;t  she  wore  one  of 
these  until  the  teeth  were  carious,  while  the  other  was  care- 
fully kept  in  water.  After  a  period  of  seven  years,  wishing 
to  change  the  worn  out  case  for  that  which  she  had  preserved 
in  water,  she  found  this  latter  just  as  corroded  as  the  one  she 
had  worn  in  her  mouth.  Does  not  this  case  find  its  explana- 
tion in  the  observations  cited  by  MM.  Wedl  and  Heider,  ac- 

*  Eecherches  sur  la  composition  de  l'email  des  dents  (Virchow's  Archiv, 
xxiv,  p.  13). 
f  Human  teeth. 


PRODUCTION    OF    CARIES.  '  75 

cording  to  which,  at  the  end  of  only  ten  days,  fungi  had  at- 
tacked the  enamel  and  tlie  dentine  of  teeth  "placed  in  pure 
water?  A  few  weeks  sufficed  to  change  the  tissues  to  such 
a  point  that  they  were  pierced  with  holes  like  a  sieve.  If 
the  action  of  acids  alone  could  occasion  caries  of  the  teeth, 
it  should  be  eas}'  to  demonstrate  the  phenomena  out  of  the 
mouth.  It  is  not  so.  Acids  cause,  it  is  true,  a  portion  of 
the  alterations  pX  caries,  but  its  totality  differs  essentially 
from  the_effeçts  which  they  produce.  Several  authors  have 
studied  the  influence  of  acids,  and  of  different  other  agents, 
upon  the  tissues  of  the  teeth.  We  will  meutioiL-espedally 
exjje  rim  en  ts  made  in  1843,  in  I^orth  America,  by  Mr.  A. 
Westcott,  with  the  assistance  of  Mr.  DaliympTe.  These  au- 
thors obtained  the  following  results: 

1st.  All  the  mineral,  as  well  as  the  vegetable  acids,  act 
promptly  upon  the  teeth.  Acetic  and  citric  acids,  for  ex- 
ample, in  forty-eight  hours,  corroded  the  enamel  to  such  a 
degree  as  to  permit  a  great  portion  of  it  to  be  scratched 
away  with  the  nail;  malic  acid  also  produced  very  rapid 
eflects. 

2d.  The  salts  whose  acids  have  a  greater  affinity  for  lime 
than  for  their  own  bases  also  acted  upon  the  teeth.  The 
acid  tartrate  of  lime  verj^  rapidly  destroyed  the  enamel; 
grapes,  at  the  end  of  forty-eight  hours,  had  already  acted  so 
strongly  that  the  surface  of  the  enamel  presented  the  appear- 
ance of  chalk. 

3d.  Vegetable  substances  have  iio  action  until  they  fer- 
ment,_ajid  acetic  acid  is  formed.  Sugar,  for  example,  which 
by  itself  had  no  action,  produced  its  effects  only  in  a  state  of 
acid  fermentation. 

4th.  Animal  substances  acted  very  slowly,  and  only  when 
they  had  reached  a  very  advanced  stage  of  putrefaction. 

Mr.  Allport  obtained  identical  results*  in  his  researches 
into  the  action  of  different  acids  upon  the  teeth,  making  use 
of  very  dilute  acids,  such  as  are  used  in  medicine.  All  the 
mineral  acids,  as  well  as  citric  and  acetic  acids,  in  a  few  hours 
produced  very  marked  action  upon  the  enamel. 

*  Vide  American  Journal  of  Dental  Science,  April  30th,  1858. 

( 
\ 


76  •       INQUIRIES    INTO    DENTAL    CARIES. 

M.  Mantegazza  engaged  in  tlie  same  investigations,  and 
obtained  identical  results.*  Sugar  acted  upon  the  teeth 
only  when,  by  eftect  of  fermentation,  it  was  partially  changed 
into  acetic  or  lactic  acid.  Lactic  acid,  vinegar,  strong  or 
diluted,  and  lemon-juice,  acted  on  the  teeth. 

We  had  begun  our  investigations  upon  caries  of  the  teeth 
when  the  book  of  M.  Magitot  appeared.f  The  results  of  his 
experiments  which  are  there  given  should  prove  not  only 
that  acids  and  the  acid  salts  act  upon  the  teeth,  but  also 
that  these  are  the  sole  agents  of  caries,  and  that  the  phe- 
nomena produced  upon  the  teeth  by  their  action  are  entirely 
identical  with  those  of  caries  of  the  teeth. 

The  substances  employed  by  M.  Magitot  in  his  experi- 
ments were,  at  first,  solutions  of  a  great  number  of  acids,  of 
some  acid  salts,  and,  moreover,  solutions  of  sugar,  albumen, 
table-salt,  and  alum.  He  submitted  teeth  to  the  action  of 
these  agents  for  two  years.  At  the  end  of  this  time,  the 
solutions  which  contained  the  teeth,  in  many  cases,  were 
covered  with  thick  coatings  of  mould  ;  the  acid  solutions 
had  sometimes  become  neutral,  and  the  teeth  were  more  or 
less  attacked,  softened,  and  destroyed.  In  a  great  number 
of  cases  the  enamel  presented  a  white,  earthy  appearance. 
It  was  chalky  and  profouudl}'  changed.  The  dentine  was 
brown  or  yellow,  deprived  of  its  salts,  and  softened,  thus 
having  the  aspect  of  carious  dentine. 

Moreover,  remarkable  ditFerences  were  observed  in  the 
action  of  agents  upon  the  ditierent  tissues  of  the  teeth.  M. 
Magitot  distinguishes,  from  the  results  of  his  experiments, 
four  categories  of  substances  in  relation  to  their  action  upon 
teeth. 

These  are,  according  to  him, 

1st.  Suhsta.nces  which  aitack_qlike  all  the  tissues  of  Jeeih.  In 
this  category  belong  the  varieties  of  sugar  (but  only  in  a 
state  of  fermentation),  lactic  acid,  butyric  acid,  citric, acid, 


*  Mantegazza  sur  l'action  du  sucre  et  de  certains  acids  sur  les  dents. 
Milan,  1862.     Trans,  in  Brit.  Jour,  of  Dent.  Se,  1804,  vol.  viii.  No.  92. 

f  Etudes  et  experiences  sur  la  salive  considérée  comme  agent  de  la  carie 
dentaire.     Paris,  1866. 


PRODUCTION    OF    CARIES.  •  77 

malic  acid,  carbonic  acid,  the  products  of  the  decomposition 
of  albumen  and  albunnnoid  substances. 

2d.  Substances  ichich  have  the  particular  and  exclusive  prop- 
erty of  destroying  the  enamel:  Alum,  oxalic  acid  and  its  acid 
salts.  '"' 

3d.  Substances  which  act  exclusively  upon  the  dentine  and, 
■upon  the  cement:  Acetic  acid,  tartaric  acid  and  their  acid 
salts,  and  tannin. 

4th.  Substances  lohich  have  no  action  upon  the  dental  ti^sues^ 
as  common  salt  and  the  great  majority  of  other  neutral  sub- 
stances which  are  found  in  the  mouth. 

These  results  do  not  entirely  agree  with  those  of  MM. 
Westcott,  Allport,  and  Mantegazza.  In  order  to  verify  the 
experiments  of  M.  IMagitot,  we  submitted  a  series  of  teeth 
to  the  action  of  the  principal  substances  used  by  this  author, 
but  we  have  not  been  able  to  convince  ourselves  that  the 
action  of  acids  alone  can  produce  clianges  identical  with 
those  of  caries. 

In  repeating  the  experiments  of  M.  Magitot,  we  have  ab- 
stained from  using  the  same  time.  If  caries  depends  upon 
simple  chemical  action  upon  the  teeth,  it  is  not  necessary  to 
wait  years  in  order  to  see  the  effect.  When  there  is  a  suf- 
ficient quantity  of  the  acid  solution,  we  are  able  to  perceive, 
at  the  expiration  of  but  few  daj^s,  a  very  considerable  alter- 
ation in  the  dental  tissues,  even  with  the  feeble  solutions 
which  M.  Magitot  has  used  in  his  experiments.  If  we  leave 
for  years  in  the  liquids  the  teeth  upon  which  we  are  experi- 
menting, without  assuring  ourselves  of  the  quantity  of  acids 
which  they  contain,  and  witliout  restoring  to  them  the  por- 
tion of  these  same  acids  which  they  lose  by  their  neutraliza- 
tion in  combining  with  the  calcareous  salts,  it  will  not  be 
possible  to  attribute  the  results  obtained  to  the  sole  influence 
of  the  acids  ;  but  it  will  be  necessary  also  to  take  account  of 
the  decomposition  taking  place  in  the  organic  substance  of 
the  tooth,  of  the  putridity  of  the  fermentation,  and  of  the 
action  of  the  vegetable  and  animal  microscopic  growths 
which  are  there  developed. 

The  acid  reaction  of  the  liquids  in  which  the  teeth  had 


78  INQUIRIES    INTO    DENTAL    CARIES. 

been  placed  had  given  place  to  a  neutral  one  in  several  of 
the  experiments  made  by  M.  Magitot.  This  proves  that  in 
the  last  portion  of  time  and  perhaps  for  a  considerable  period 
the  acids  had  taken  no  part  in  the  destruction  produced. 

If  the  work  of  caries  is,  in  general,  much  slower  in  the 
mouth,  this  may  depend  on  the  habitual  want  of  a  sutiicient 
quantity  of  acids.  Perhaps  these  exert  their  action  only  in- 
termittently, and  each  time  during  a  rather  short  period. 
Our  own  researches  upon  the  penetration  of  le'ptothrix  into 
the  interior  of  dental  substances,  and  the  observations  of 
M^r.  Wedl  and  Heider  upon  the  introduction  of  fungi  into 
teeth  which  have  been  extracted,  demonstrate,  according  to 
the  evidence,  the  part  which  may  be  due  to  these  agents  in 
M.  Magitot's  experiments. 

Nevertheless,  as  no  investigations  upon  these  corroded 
teeth  have  been  made  with  the  microscope,  we  have  noth- 
ing but  presumptions.  The  resemblance  to  caries  which 
has  been  found  in  these  experiments  relates  therefore  only 
to  the  diminution  of  the  consistency  of  the  enamel,  which 
became  tender  and  friable  as  in  caries,  with  a  brown  or  yel- 
low color,  and  to  a  more  or  less  advanced  softening  of  the 
dentine.  This  softening  sometimes  reached  a  very  high 
degree. 

But  these  external  resemblances  do  not  prove  that  this 
was  veritable  caries,  and,  even  if,  by  microscopical  research, 
symptoms  had  been  found  identical  with  those  of  caries,  it 
would  not  then  be  demonstrated  that  they  are  due  exclu- 
sively to  the  action  of  acids. 

It  follows  that  the  results  of  our  experiments  are  not  com- 
pletely accordant  with  those  of  M.  Magitot,  while  they  con- 
firm precisel}^  those  obtained  by  MM.  Westcott,  AUport,  and 
Mantegazza. 

^Ye  have  found  that  all  substances  capable  of  changing 
the  dental  tissues  produce,  at  first,  a  deterioration  of  the 
enamel,  which  is  soon  followed  by  that  of  the  dentine.  The 
enamel,  which,  in  its  normal  state,  is  transparent,  becomes 
white  and  opaque,  milky,  and,  in  a  more  advanced  state, 
chalky.     At  the  beginning,  and,  above  all,  when  the  enamel 


PRODUCTION    OF    CARIES.  79 

is  very  hard,  there  is  sometimes  seen  only  a  whitish  color 
and  the  disappearance  of  the  transparency.  The  surface 
may,  in  such  cases,  remain  polished  and  shining  ;  later,  it 
hecomes  rough  and  uneven,  and  the  enamel  thus  acquires  an 
earthen,  chalky  appearance.  The  softening  increases  little 
by  little,  and  gains  in  depth  ;  so  that  in  a  short  time  we  can 
scratch  awa}^  the  enamel  with  the  nail,  or  break  it  off  in 
bits.  In  using  certain  acids,  which  form  salts  difficult  of 
solution,  we  see  the  enamel  and  also  the  root  covered  with 
innumerable  and  very  beautiful  crj'Stals. 

"When  the  enamel  presents  the  first  degree  of  alteration, 
the  appearance  of  the  dentine  and  also  that  of  the  cement  is 
normal,  and  its  hardness  has  not  as  yet  undergone  any 
change  ;  we  recognize  the  alteration  which  follows  by  a 
more  transparent  look  to  the  roots,  which,  at  first,  can  be 
cut  with  a  knife  at  the  surf^ice  ;  soon  after  we  can  cut  them 
more  deeply  ;  at  a  more  advanced  period  we  can  even  bend 
them.  It  is  true  that  sound  dentine  can  also  be  slightly  cut 
with  a  knife,  but,  in  doubtful  cases,  it  has  always  been  our 
habit  to  compare  the  dentine  submitted  to  the  action  of 
acids  with  normal  dentine. 

In  proof  of  our  statements  w^e  give  here  a  few  extracts 
from  our  experiments. 

1st.   Tartaric  Add. 
{a.)  Solution  ^l  in  100. 

At  the  end  of  two  days  the  enamel  was  seen  to  be  covered 
with  minute  crystals  ;  these  removed,  the  enamel  had  lost 
its  brilliancy  and  taken  a  white,  earthy  aspect.  Xo  change 
remarked  at  the  root. 

At  the  end  of  eight  days  the  alteration  of  the  enamel  was 
increased  :  with  a  knife  slices  could  be  taken  from  the 
surface. 

At  the  end  of  a  fortnight  the  alteration  of  the  enamel  had 
made  new  progress,  while  the  root  was  only  slightly  softened 
at  the  surface. 


80  INQUIRIES    INTO    DENTAL    CARIES. 

[b  )  Grapes. 

Some  teeth  were  placed  among  crushed  grapes  whose  juice 
was  rather  acid. 

After  forty-four  hours  the  surface  of  the  enamel  was  very 
rough  and  covered  with  numerous  crystals.  Upon  brushing 
these  away,  the  enamel  appeared  uneven  and  slightly  chalky  ; 
its  brilliancy  was  gone.  The  root  was  likewise  slightly  cov- 
ered with  minute  crystals  ;  it  had  not  yet  undergone  notice- 
able change. 

At  the  end  of  eleven  days  the  experiment  was  ended.  The 
divided  enamel  presented,  throughout  its  whole  thickness, 
an  earthy,  white  appearance,  and  was  porous  ;  the  root  was 
scarcely  changed. 

2d.  Acetic  Acid. 

Solution  Jj^  ix  100. 

At  the  end  of  ten  days  the  enamel  was  found  to  have  on  its 
anterior  surface  an  earthy,  white  appearance  ;  it  could  be 
removed  with  the  finger-nail  ;  while,  on  the  posterior  sur- 
face, it  remained  almost  in  its  normal  state.  The  surface  of 
the  root  could  be  cut  with  a  knife. 

A  i  the  end  of  seventeen  days  the  enamel  could  everywhere 
be  broken  ofl'in  great  pieces  ;  the  subjacent  dentine  was  also 
decalcified.     With  a  knife  the  root  could  be  easily  cut. 

3d.  Oxalic  Acid. 
Solution  ^l  ix  lOO. 

After  seven  days  the  bottom  of  the  glass  was  covered  with 
a  thick  laj'er  of  white  powder  composed  of  minute  crystals 
of  oxalate  of  lime.  The  enamel,  of  an  earthy  white,  could 
be  removed  with  the  finger-nail  ;  a  part  of  the  crown  had 
preserved  its  polish.     The  root  did  not  seem  altered. 

At  the  end  of  fourteen  days  the  enamel  Avas  everywhere  of 
an  earthy  white,  and  could  be  easily  removed  with  the  nail. 
The  root  could  be  cut  with  a  knife,  especially  at  the  ends, 
with  o^reater  ease  than  in  its  normal  state. 


PRODUCTION    OF    CARIES.  81 

4-th.  Alum. 

Solution  1  in  100. 

At  the  end  of  tim  days  no  trace  of  clian2;e. 

After  six  days  the  polish  at  the  lower  part  of  the  enamel 
was  seen  to  be  (Jiminished,  and  the  enamel  was  covered  at 
the  same  part  with  a  light  earthy  layer  which  was  easily 
removed.     The  root  appeared  to  remain  intact. 

At  the  end  of  twenty  days  the  enamel  could  be  easily  re- 
moved with  the  nail  ;  no  other  changes.  The  root  could  be 
cut  more  readily  than  in  the  normal  state. 

5th.  Lactic  Acid. 

{a.)  Solution  J^  in  100. 

At  the  end.  of  ten  days  it  was  impossible  to  perceive  any 
alteration  in  one  of  the  teeth,  a  very  strong  molar;  in  another 
tQoth  the  enamel  was  everywhere  whitened,  part  roughened, 
part  still  polished  ;  everywhere  it  was  easily  removed.  The 
root  was  not  sensibly  altered. 

After  seventeen  days,  on  the  first  tooth  was  seen,  at  the 
extremity  of  the  crown,  a  slight  milky  color  without  loss  of 
polish.  At  this  part,  with  a  knife,  small  shavings  could  be 
removed.  Eoot  intact.  On  the  second  tooth  the  alteration 
of  the  enamel  had  increased  ;  its  root  could  be  cut  with  a 
knife  more  easily  than  in  its  normal  state. 

(b.)  Solution  1  in  100. 

After  two  days  the  enamel  was  earthy  and  without  polish  ; 
tlie  root  was  normal. 

At  the  end  of  thirteen  days  the  enamel  could  be  everywhere 
removed  with  the  nail.  The  root  was  decalcified  on  tlie  sur- 
face ;  it  was  easily  cut  with  a  knife,  but  only  to  a  slight 
depth. 

It  appeared  to  us  superfluous  to  prolong  further  our  ex- 
periments ;  we  usually  interrupted  them  after  having  become 
well  satisfied  that  the  dentine  was  beginning  to  be  decalcified  ; 


82  INQUIRIES    INTO    DENTAL    CARIES. 

any  ulterior  action  possessed  no  interest  for  us,  and  we  cared 
little  to  know  if  it  was  possible  to  completely  decalcify  the 
teetli  or  not  by  the  aid  of  diiierent  concentrations  of  acids. 
"We  have  been  able  to  convince  ourselves,  in  some  of  our  ex- 
periments in  which  the  teeth  have  remained  subjected  to  the 
action  of  acids  for  a  long  time,  that  it  is  possible  even  with 
very  weak  acid  solutions  to  decalcify  teeth  pretty  completely. 

It  results,  from  the  experiments  which  have  just  been 
related,  that  tartaric  and  acetic  acids,  even  yjry  \\ieak,jpi'0- 
duce  upon  the  enamel  the  same  changes  as  other,  espeMally 
the  lactic  and  oxalic  acids,  while  M.  Magitot  asserts  that 
tartaric  and  acetic  acids  attack  only  the  dentine  and  never 
the  enamel.  ^Ve  know  not  how  M.  Magitot  has  obtained 
such  opposite  results;  we  content  ourselves  with  remarking 
that  he  also  noticed  that  tartaric  acid  had  produced  a  layer 
of  little  crj'stals  upon  the  surface  of  the  enamel,  and  that 
they  adhered  to  it  sometimes  very  strongly.  Yet,  according 
to  him,  beneath  these  crystals  the  enamel  was  found  in  a 
normal  state.  We,  on  the  contrary,  have  noticed,  after 
having  removed  these  crystals,  that  the  surface  was  left  un- 
even and  roughened  ;  the  enamel  was  transformed  to  an 
earthy  mass  even  to  a  great  dej^th.  Perhaps  this  difference 
of  results  can  be  explained  by  the  supposition  that  in  the 
experiments  of  ]\I.  Magitot,  although  there  may  have  been 
no  loss  of  substance  in  the  enamel,  yet  it  may  have  been 
transformed  into  a  chalky  mass.  On  the  other  hand,  it  is 
possible  that  the  differences  in  the  consistency  and  perhaps 
also  in  the  chemical  composition  of  the  enamel,  fram  which 
results  a  different  resistance  to  the  action  of  acids,  have  acted 
in  the  manner  described  in  our  experiment  Xo.  5. 

Our  experiments  are  in  harmony  with  those  of  Afr.  West- 
cott,  of  Mr.  Allport,  and  of  M.  ]N[antegazza,  who  found  that 
all  the  vegetable  acids,  without  distinction,  attacked  the 
enamel  of  the  teeth. 

Our  experiments  do  not  permit  us  to  admit,  as  M.  Magitot 
asserts,  that  oxalic  acid  and  alum  attack  neither  the  cement 
nor  the  dentine.  It  is  true  that  the  diminution  of  the  hard- 
ness of  the  dentine  beo-ins  always  later  than  the  lirst  altera- 


PRODUCTION    OF    CARIES.  83 

tion  of  the  enamel,  but  all  the  acids  produce  the  same  eftect; 
so  we  stopped  pushing  farther  our  experiments,  with  the  end 
of  decalcifying  more  completely  the  dentine.  It  would  be 
easy  to  show  the  diminution  of  the  hardness  of  the  root  of 
the  tooth  by  the  action  of  oxalic  acid,  or  of  a  solution  of 
alum  ;  nevertheless,  it  appeared  to  us  that  oxalic  acid,  tar- 
taric acid,  and  solutions  of  alum,  attack  the  dentine  a  little 
more  slowly  than  does  acetic  acid,  for  example;  lactic  acid 
much  weakened,  acts  also  very  slowly. 

The  specific  action  which  M.  Magitot  has  attributed  to 
certain  substances  upon  the  dental  tissues  must  therefore 
have  for  cause  some  fortuitous  circumstance,  inasmuch  as 
subsequent  experiments,  made  in  the  same  manner,  entirely 
fail  to  confirm  it. 

As  for  the  action  of  sugar,  all  experiments  result  in  show- 
ing that  in  its  normal  state  it  never  attacks  the  teeth;  it 
acts  only  on  passing  into  the  state  of  acid  fermentation.  We 
have  obtained  identical  results.  The  most  decisive  experi- 
ments upon  this  point  have  been  made  by  M.  Magitot.  He 
boiled  a  solution  of  sugar,  deposited  the  teeth  in  it,  and  closed 
the  neck  of  the  bottle  hermetically,  by  heating  it  to  a  white 
heat,  drawing  out  and  twisting  it.  No  fermentation  was 
then  possible,  and  at  the  expiration  of  two  years  the  teeth 
were  found  entirely  untouched. 

The  difterent  action  of  acids  upon  the  different  tissues  of 
the  teeth  is  explained  by  the  presence  of  variable  proportions 
of  organic  substances  which  enter  into  the  composition  of 
the  enamel,  the  dentine,  and  the  cement. 

In  the  enamel,  where  the  organic  substances  enter  only  in 
the  proportion  of  some  hundredths,  the  least  diminution  of 
the  salts  should  produce  great  disorder  in  the  molecular  com- 
position, and,  consequently,  upon  the  physical  properties  of 
this  tissue;  while  a  slight  loss  of  inorganic  substance  would 
not  be  easily  perceived  in  the  dentine,  for  the  organic  mat- 
ters which  it  contains  would  suffice  to  maintain  its  consis- 
tence. 

The  enamel,  stripped  of  its  calcareous  salts,  possesses  only 
a  minute  quantity  of  organic  elements, ^which,  placed  under 


84  INQUIRIES  INTO  DENTAL  CARIES. 

the  microscope,  present  for  ouly  an  instant  the  enamel  struc- 
ture; they  are  seen  promptly  to  dissolve.  The  dentine, 
deprived  of  its  salts,  has,  on  the  contrary,  the  consistence 
of  cartilage,  and  entirely  keeps  the  form  of  undecalciiied 
dentine. 

The  acids  produce  upon  the  enamel  phenomena  which  are 
likewise  found  in  caries  of  the  enamel  ;  thus,  these  latter 
may  be  explained  by  the  action  of  acids.  In  both  cases  the 
enamel,  being  deprived  of  a  portion  of  its  salts,  becomes  por- 
ous, opaque,  and  softer. 

Out  of  the  mouth  the  action  of  acids  is  always  perceived 
first  upon  the  enamel.  It  remains  to  be  ascertained  if  the 
dissolution  of  the  calcareous  salts  of  the  dentine  does  not 
take  place  at  the  same  time  as  that  of  the  enamel,  although 
not  manifesting  itself  to  the  observer  until  later.  AVe  are  in- 
clined to  think  so,  inasmuch  as  we  have  no  reason  for  admit- 
ting that  the  salts  of  the  dentine  are  less  soluble  than  those 
of  the  enamel.  As  for  the  rest,  there  are  in  the  hardness  of 
the  enamel  and  of  the  dentine  differences  which  predispose 
them  to  be  more  or  less  rapidly  attacked,  and  whose  influence 
U23on  the  production  of  caries  we  have  long  appreciated. 

As  to  the  utility  of  all  these  experiments,  the}'  teach  us 
that  sugar  and  sugared  liquids,  placed  in  circumstances 
favorable  to  acid  fermentation,  are  able  to  exercise  by  this 
alteration  an  injurious  action  upon  the  teeth.  In  the  mouth 
are  found  all  conditions  favorable  to  this  fermentation,  there- 
fore all  solutions  of  sugar  are  capable  of  acting  in  precisely 
the  same  manner  as  acids. 

To  sugar  is  very  generally  attributed  an  injurious  action 
upon  the  teeth.  That  this  opinion  is  well  founded  is  con- 
firmed by  the  oft-repeated  observation  that  caries  is  especi- 
ally common  and  intense  with  persons  of  certain  professions, 
such  as  confectioners  and  cooks,  who  eat  or  taste  many  sweets, 
and  who,  moreover,  take  sugar  into  the  mouth  in  the  form 
of  dust  while  jjulverizing  or  sifting  it. 

It  is  true  that  other  observations  would  seem  to  prove  the 
contrary.  The  blacks  of  the  East  Indies  who  eat  enormous 
quantities  of  sugar  are  remarkable  for  very  beautiful  and 


PRODUCTION    OF    CARIES.  85 

very  sound  teeth.  M.  Mantegazza  confirms  tliis  fact  by  Ins 
own  experience,  and  adds  further  that  the  Indians,  who  eat 
constantly  the  sugar  cane  and  other  products  of  their  coun- 
try rich  in  sugar,  have  likewise  excellent  teeth.  ]^everthe- 
less,  M.  Mantegazza  does  not  attach  much  weight  to  these 
observations;  he  thinks  that  these  populations  differ  from 
us  in  their  whole  organization  too  much  for  us  to  be  justified 
in  drawing  from  them  conclusions  applicable  to  civilized 
people.  Yet  we  may  deduce  from  these  facts  the  consequence 
that  teeth  w^ell  developed,  hard,  and  strong,  will  not  suffer 
from  even  the  freest  use  of  sugared  aliments,  while  those  of 
a  less  dense  structure  may  suffer  from  it  considerably. 

It  would  seem  to  result  from  all  this  that  the  Europeans, 
and  the  races  sprung  from  them,  as  for  example,  the  iSTorth 
Americans,  have  teeth  less  perfectly  developed,  and  less  re- 
sistant than  the  negroes  aud  the  natives  of  America.  From 
this  we  are  not  permitted  to  attribute  the  great  amount  of 
caries  of  the  teeth  which  is  found  among  the  Europeans  and 
ISTorth  Americans  solely  to  their  more  refined  manner  of  liv- 
ing, and  to  the  use  of  substances  little  favorable,  and  even 
injurious  to  the  teeth;  but  we  are  compelled  to  admit  that, 
with  them,  the  disposition  and  the  development  of  the  teeth 
are  less  perfect. 

It  is  impossible  for  us  here  to  enlarge  further  upon  the 
causes  of  these  singular  phenomena,  which  refer  evidently  to 
the  characteristic  development  of  the  races.  We  must,  how- 
ever, refer  in  this  connection  to  the  remarkable  differences 
in  frequency  of  caries  in  the  different  parts  of  France;  M. 
Magitot  has  given  special  attention  to  this  point.* 

The  experiments  which  we  have  made  upon  the  action  of 
acids  upon  teeth  have  led  us  on  to  a  series  of  other  observa- 
tions which  have  reference  to  the  origin  of  caries  of  tlie  teeth. 

Some  observations  establish  that,  at  the  end  of  a  somewhat 
prolonged  course  of  grape  cure,  patients  have  perceived  that 
their  teeth  have  become  affected.  Their  surfaces  have  be- 
come rough,  a  superficial  layer  of  enamel  has  been  destroyed, 


*  Traité  de  la  carie  dentaire,  p.  61-66. 


86  INQUIRIES    INTO    DENTAL    CARIES. 

and,  ill  some  cases,  true  caries  has  been  developed.  "We  can 
confirm  from  our  own  experience  the  fact  of  the  roughness 
of  the  teeth,  and  the  production  of  caries  as  a  result  of  courses 
of  grape  cure.  In  one  case,  where  the  teeth  were  extraordin- 
arily hard  and  dense,  and  where  the  cure  had  been  interrupted 
at  the  moment  when  the  teeth  began  to  grow  rough,  there 
was  no  caries,  and  the  roughness  gradually  disappeared.  In 
other  cases,  on  the  contrary,  a  greater  or  less  loss  of  enamel 
W'as  observed,  and  caries  appeared.  The  roughness  is,  with- 
out doubt,  the  consequence  of  the  alteration  of  the  superficial 
layers  of  the  enamel,  and  the  deposit  of  very  minute  crystals 
of  tartrate  of  lime,  as  we  have  seen  produced  in  our  experi- 
ments with  tartaric  acid  and  the  juice  of  the  grape.  It  will 
therefore  be  well  to  caution  those  -whose  teeth  are  of  poor 
quality  against  the  use  of  such  cures,  except  with  the  utmost 
precaution,  forewarning  them  that  the  juice  of  the  grape  may 
injure  their  teeth. 

Afte_r  having  established  by  our  experiments  that  acids  of 
the  most  various  kinds  attack  the  teeth,  it  behooves  us  to 
inquii-e  what  are  the  acids  which  take  part  in  the  caries  of 
the  teeth,  and  how  they  get  into  the  mouth.  "We  know 
that  acids  are  always  introduced  into  the  mouth  with  our 
food  and  drink:  acetic  acid  is  associated  with  great  numbers 
of  viands  as  a  condiment  ;  malic,  citric,  and  tartaric  acids 
are  found  in  different  kinds  of  fruits,  and  in  the  drinks 
which  are  made  from  them  ;  oxalic  acid  is  found  in  certain 
plants;  lactic  acid  in  sour  milk,  and  so  on.  AVe  have,  more- 
over, pharmaceutic  remedies  which  contain  mineral  acids 
and  their  acid  ethers;  then  tannin,  some  salts,  alum,  for  in- 
stance, are  able  to  attack  the  teeth.  All  these  sul)stances 
may  easily  bring  on  caries  or  contribute  to  hasten  its  prog- 
resa;  but  we  think  that  the  acids  formed  in  the  mouth  as 
the  result  of  decomposition,  or  those  which  are  found  in  the 
buccal  secretions,  play  in  this  matter  a  much  more  important 
part.  The  liquid  which  exists  in  the  buccal  cavity  is  com- 
posed, as  is  well  known,  of  a  mixture  of  the  secretions  of  the 
salivary  glands  and  of  the  mucous  follicles  of  the  mouth. 
The  secretions  of  these  different  glands  are  almost  all,  at 


PRODUCTION    OF    CARIES.  87 

least  in  the  normal  state,  neutral  or  alkaline  ;  the  liquids, 
then,  which  are  in  the  mouth,  cannot  be  acid,  not  taking 
into  consideration  the  acids  which  are  directly  introduced 
either  by  an  anomaly  in  the  secretion,  or  else  in  consequence 
of  fermentation  caused  by  particles  of  food  remaining  in  the 
mouth. 

Among  the  secretions  of  the  salivary  glands,  that  of  the 
parotid  alone  may  be  feebly  acid  ;  that  of  the  submaxillary 
and  sublingual  glands  is,  on  the  contrary,  constantly  alkaline. 
This  fact  has  been  proved  by  the  aid  of  sounds  introduced 
into  the  efterent  canals  of  these  glands.  The  secretion  of 
the  parotid  is  sometimes  acid  when  first  collected  ;  but  this 
reaction  passes  promptly  to  the  neutral  state,  or  to  one 
slightly  alkaline,  when  the  liquid  loses  the  clearness  which 
it  possessed  at  first.  This  acid  reaction  arises,  according  to 
M.  Œhl,*  from  the  carbonic  acid  absorbed  in  the  liquid, 
which  holds  in  solution  the  carbonate  of  lime  with  which 
the  liquid  secreted  by  the  parotid  is  abundantly  provided. 
When  the  carbonic  acid  disappears,  the  acid  reaction  ceases 
to  take  place  and  the  carbonate  of  lime  which  it  holds  in 
solution  is  precipitated. 

This  circumstance  explains  the  formation  of  the  tartar 
upon  the  teeth.  The  fact  that  this  sometimes  contains  a 
large  quantity  of  pliosphate  of  lime  at  the  same  time  with 
the  carbonate  is  not  in  contradiction  with  this  explanation, 
inasmuch  as  the  carbonic  acid  may  hold  phosphate  as  well 
as  carbonate  of  lime  in  solution.  The  precipitates  of  the 
calcareous  salts  inclose  numerous  elements  of  leptothrix  and 
of  other  products  which  are  met  with  in  the  mucosities  of 
the  mouth,  such  as  epithelial  cells,  leucocytes,  &c.,  as  we 
have  hereinbefore  shown. 

The  numerous  minute  follicles  of  the  buccal  cavity  secrete 
a  liquid  which  goes  by  the  ordinary  name  of  buccal  mucus, 
and  which,  very  probably,  in  its  properties  resembles  the 
secretions  of  the  submaxillary  and  sublingual  glands.     Ac- 

*  La  saliva  liumana,  &c.  Puvia,  1864.  Vide  Meissner's  Jahresber. 
(Meissner's  Annalen  f.  rat.  Med.,  xxv  Bd.  2  H.,  S.  242.) 


88  INQUIRIES    INTO    DENTAL    CARIES. 

cording  to  their  seats  tliey  are  called  follicles  of  the  lips,  of 
the  cheeks,  of  the  palate,  of  the  tongue.  Their  structure  is 
perfectly  identical  with  that  of  the  salivary  glands,  and  their 
secretions  contain,  like  those  of  the  suhniaxillary  and  suh- 
lingual  glands,  a  great  quantity  of  mucus  which  conies  from 
the  epithelial  cells  of  the  follicles,  while  the  secretion  of  the 
parotid  is  very  liquid  and  contains  no  mucus. 

The  particular  reaction  of  the  mucous  secretion  furnished 
by  the  buccal  cavity  naturally  cannot  be  established  in  a 
direct  manner  in  man;  nevertheless,  from  the  fact  that  the 
mixture  of  all  the  secretions  of  the  mouth,  which  constitutes 
the  ordinary  saliva,  has,  as  a  rule,  an  alkaline  or  neutral  re- 
action, we  may  conclude  that  the  secretion  of  the  mucous 
follicles  of  the  mouth  is  in  like  manner  neutral  or  alkaline. 
This  has  been  proved  directly  b}'  an  exiieriraent  made  on  a 
dog  b}'  M.  CI.  Bernard.  After  having  made  a  section  of  all 
the  salivar}^  conduits,  he  found  that  the  liquids  contained  in 
the  mouth,  which  clearly  could  no  longer  be  mixed  with 
secretions  supplied  by  the  salivary  glands,  were  alkaline  ; 
the  secretion  of  the  mucous  follicles,  at  least  of  dogs,  must 
then  be  alkaline. 

It  has  also  been  asserted  that  the  mucous  membrane  of 
the  buccal  cavity  can,  independently  of  the  mucous  follicles 
which  it  contains,  give  out  an  acid  secretion,  especially"  when 
irritated. 

Mr.  Tomes  shares  this  opinion,  which  he  rests  principally 
on  TIîê^Tact  that  cotton  placed  between  the  teeth,  in  such  a 
manner  as  to  irritate  the  gum,  evidently  favors  the  progress 
of  the  caries  which  exists  at  any  point.  But  these  facts  can 
be  refuted  by  considering  that  the  cotton,  as  a  porous  sub- 
stance, must  necessaril}'  favor  the  work  of  decomposition 
and  of  fermentation  which  is  going  on  at  this  spot.  It  has 
not  as  yet  been  showai  directly,  and  we  may  say  that  it  is 
not  very  probable,  that  the  mucous  membrane  of  the  mouth, 
aside  from  the  secretions  of  the  glands  which  it  contains, 
-.jiecretes  a  fluid  peculiar  to  itself  in  any  great  abundance. 

it  is,  nevertheless,  a  fact  which  is  commonly  observed, 
that  the  interior  of  the  mouth,  but  above  all,  the  surface  of 


PRODUCTION    OF    CARIES.  89 

the  teeth  and  gums,  shows  aii_acid  reaction.  This  reaction 
may,  <x ^non,  he  attributed  to  two  causes:  first,  to  the  ab- 
normaT^nature  of  the  secretions  of  the  mouth,  and,  second, 
to  an  acid  fermentation  of  particles  of  food. 

As  for  the  reaction  of  the  liquids  of  the  mouth,  we  have 
already  remarked  that  the  secretions  of  the  parotid  possess, 
in  most  cases,  an  acid  reaction  ;  hence  it  may  be  presumed 
that,  in  given  circumstances,  the  acidity  of  the  saliva  may 
be  sufficiently  increased  for  the  teeth  to  be  affected  by  it. 
The  momentary  acid  reaction  which  the  secretion  of  the 
parotid  possesses  in  the  normal  state,  and  which  is  caused  by 
carbonic  acid,  can  naturally  have  no  injurious  influence  upon 
the  teeth,  seeing  that  it  is  even  powerless  to  prevent  the  tar- 
tar from  precipitating  from  it.  If  this  acid  saliva  were  able 
to  dissolve  a  greater  quantity  of  calcareous  salts  than  that 
which  it  already  holds  in  solution,  we  should  never  see  any 
portion  of  these  salts  form  a  precipitate  ;  but,  as  all  saliva 
deposits  more  or  less  tartar,  it  is  very  improbable  that  it  can, 
in  general,  attack  the  teeth. 

It  is  true  that  cases  are  found,  where  the  caries  has  a  very 
rapid  progress,  in  which  there  is  almost  a  total  absence  of 
deposits  of  tartar  ;  but  we  generally  find  in  such  cases  a 
diminution  of  the  salivary  secretion,  which  explains  the  ab- 
sence of  tartar.  The  acids  which  form  in  the  mouth  are  no 
longer  neutralized  and  diluted  by  the  saliva  ;  therefore  they 
have  a  greater  facilitj'  for  attacking  the  teeth.  We  believe, 
on  the  contrary,  that  the  saliva  protects  the  teeth  against 
the  action  of  acids,  from  Avhence  arises  the  particular  immu- 
nity which  the  canines  and  incisors  of  the  lower  jaw  seem  to 
possess;  teeth  which  are  constantl}^  bathed  in  saliva.  Those 
persons  who  secrete  but  a  small  quantity  of  saliva  have  pre- 
dispositions to  caries  of  the  teeth  ;  a  particular  predisposition 
to  this  aftection  springs,  in  like  manner,  from  the  diminution 
of  the  saliva  which  takes  place  during  the  course  of  certain 
maladies. 

The  action  of  tobacco-smoke,  which  favors  the  salivary 
secretion,  appears  to  be  salutary  ;  in  no  case  does  it  ever 

7 


90  INQUIRIES  INTO  DENTAL  CARIES. 

exert  an  injurious  eftect  upon  the  teeth,  although,  in  time, 
it  gives  them  a  color  far  from  agreeable. 

An  acid  reaction  has  often  been  attributed  to  the  secretion 
of  the  mucous  follicles  of  the  buccal  cavity.  This  opinion  is 
based  upon  a  layer  of  mucus  situated  upon  the  surface  of  the 
interior  of  the  mouth,  and,  especially,  upon  the  gums  and 
teeth,  which  has  an  acid  reaction,  and  in  which  are  found 
tlie  elements  of  leptofhrix,  the  epithelial  cells  of  the  mouth, 
leucocytes,  &c.  It  appears,  nevertheless,  that  the  acid  reac- 
tion has  nothing  in  common  with  the  follicular  secretion  ;  it 
should  be  attributed  to  the  acid  fermentation  which  takes 
place  in  this  secretion,  or  in  the  saliva  mixed  with  starchy 
or  sugary  liquids.  It  is  when  fasting  that  the  acid  reaction 
is  the  most  marked  ;  that  is  to  saj',  at  the  moment  when  the 
salivary  secretion  is  reduced  to  its  minimum,  so  that  the 
acids  which  form  are  not  at  once  neutralized  and  diluted. 
M.  Œhl,  nevertheless,  found  that,  even  when  fasting,  no 
acid  reaction  took  place  when  the  mouth  had  been  scrupu- 
lously rinsed  after  eating, 

M.  Œhl  has  made  a  comparison  between  the  changes  which 
take  place  in  pure  saliva  and  that  mixed  with  alimentary 
débris,  when  exposed  to  the  air.  lie  collected  one  portion 
of  saliva  after  the  ingestion  of  amylaceous  substances,  and 
another  after  the  mouth  had  been  thoroughly  rinsed.  The 
two  liquids  destined  for  the  experiment  were  then  filtered, 
and  left  to  themselves.  The  former,  which  contained  starch, 
reduced  sulphate  of  copper,  proving  that  a  portion  of  the 
starch  had  been  converted  into  sugar.  It  remained  several 
days  in  a  state  of  acid  fermentation  before  passing  to  the 
state  of  putrefaction  with  alkaline  reaction.  In  the  second 
liquid,  which  contained  only  pure  saliva,  there  was  no  acid 
reaction,  but  on  adding  starch  or  sugar  to  this  saliva,  primi- 
tively pure,  in  like  manner  as  in  the  former,  an  acid  fermen- 
tation was  seen  to  take  place.  îs^evertheless,  the  presence  of 
the  saliva  was  necessary  to  produce  this  acid  fermentation, 
inasmuch  as  a  solution  of  starch  paste,  or  of  sugar,  free  from 
all  other  mixture,  and  placed  in  the  same  conditions,  did  not 
become  acid  in  the  same  space  of  time.     Where  sugar  or 


PRODUCTION    OF    CARIES.  91 

starch  was  held  in  the  mouth,  when  its  reaction  was  alkaline, 
an  acid  reaction  was  found  at  the  end  of  from  twenty  to 
forty  minutes,  and  even  sooner,  when  grape  sugar  was  used. 
The  acid  reaction  of  the  saliva  which  we  meet  in  persons 
afflicted  with  diabetes  is,  according  to  M.  Œhl,  due  to  the 
same  cause,  inasmuch  as  sugar  is  found  not  only  in  the  urine 
of  such  persons,  but  in  nearly  all  the  secretions,  and  especi- 
ally in  the  saliva.  The  secretion  of  the  parotid  was  able  in 
the  first  experiments  to  give  by  itself  an  acid  reaction,  which 
was  not  the  case  with  the  saliva  coming  from  the  submax- 
illary glands,  but  was  from  a  mixture  of  the  two,  especially 
when  mixed  with  mucus.  The  acid  arising  from  this  fer- 
mentation is,  according  to  M.  Œhl,  probably  the  lactic. 

It_results  from  these  experiments  that  the  saliva  of  man, 
when  starch  or  sugar  is  mixed  with  it,  can  produce  an  acid 
fermentation,  and  that  an  identical  fermentation  can  take 
place  in  the  mouth.  The  possibility  of  the  acid  fermentation 
of  a  solution  of  starch  is  subordinated  to  the  propert}^  pos- 
sessed by  the  saliva  of  changing  starch  into  sugar,  which,  in 
contact  with  a  ferment,  undergoes  an  acid  fermentation.  It 
is  now  acknowledged  that,  in  man,  it  is  not  only  the  mixture 
of  the  difterent  secretions  of  the  mouth,  but  also  the  isolated 
secretion  of  the  parotid  and  that  of  the  submaxillary  glands 
which  are  able  to  change  starch  into  sugar. 

If,  according  to  this,  the  acid  reaction  of  the  mouth  should 
be  attributed  chiefly  to  the  presence  of  alimentary  débris,  we 
should  always  take  into  consideration  the  relative  quantity 
of  saliva  and  of  mucus.  Besides  the  influence  exercised  by 
the  quantity  of  the  saliva,  whose  action  is  to  dilate  and  to 
neutralize  the  acids,  a  greater  quantity  of  mucus  may  also 
possess  importance,  inasmuch  as,  by  its  viscosity,  it  hinders 
the  too  rapid  mixture  with  the  saliva,  a  fact  which  explains 
the  possibility  of  finding  locally,  at  the  surface  of  the  teeth, 
for  example,  acids  inclosed  in  a  thick  m  ucus  ;  whilst,  in  other 
portions  of  the  buccal  cavity,  a  neutral  reaction  can  be  found,, 
or  even  one  slightly  alkaline. 

In  opposition  to  our  opinion,  which  consists  in  asserting- 
that  the  acid  reaction  is  caused  chiefly  by  alimentary  débris 


92  INQUIRIES    INTO    DENTAL    CARIES. 

in  tlie  month,  it  may  be  objected  that  during  the  course  of 
certain  acute  diseases,  and  especiall}^  in  typhoid  fever,  the 
teeth  are  strongly  attacked  by  caries,  and  that,  in  spite  of 
the  diet  habitually  prescribed,  there  is  an  increase  of  acidity. 
It  must,  nevertheless,  be  considered  that  the  diet  is  never 
absolute,  and  that  constantly  sugar,  and  very  often  acids, 
are  introduced  into  the  mouth  by  means  of  medicines;  the 
amount  of  this  sort  of  drinks  is  indeed  considerable,  on  ac- 
count of  the  thirst  from  which  patients  suffer.  A  cause,  in 
like  manner  very  important  in  the  production  of  an  acid  fer- 
mentation in  these  maladies,  is  the  diminution  of  the  salivary 
secretions,  which  are  more  concentrated,  and  contain  more 
mucus,  so  that  the  elements  necessary  to  fermentation  are 
not  wanting;  whilst  the  acids  which  are  formed,  on  account 
of  the  small  quantity  of  saliva,  cannot  be  properly  diluted  or 
neutralized. 

The  lack  of  mastication  must  at  the  same  time  favor  in 
certain  parts  of  the  buccal  cavity  the  accumulation  of  viscous 
mucus  in  a  state  of  acid  fermentation.  Under  the  influence 
of  like  causes  there  is  established  in  the  mouth  an  enormous 
mass  of  elements  of  leptothrix^  which  form  upon  the  tongue 
and  teeth  a  portion  of  the  sooty  layer,  Avhitish  at  first,  after- 
wards dry  and  brown,  which  is  found  there. 

The  most  various  irritations  of  the  buccal  cavity,  and  gen- 
erally all  the  acute  or  chronic  affections  of  the  digestive 
canal,  as  well  as  the  acute  idiopathic  maladies,  exercise  an 
influence  upon  the  production  of  caries.  Likewise,  in  these 
maladies,  the  mouth  contains  a  greater  quantity  of  this  vis- 
cous coating,  which  gives  an  acid  reaction.  It  appears  that, 
in  these  cases,  the  mucus  mixes  in  considerable  proportions 
with  the  secretions  of  the  buccal  cavity,  whilst  the  quantity 
of  saliva  is  not  positively  diminished.  But  it  is  just  the 
great  viscosity  of  the  mucus  which  hinders  the  mingling  of 
the  liquids  in  the  mouth,  and  favors  the  production  of  par- 
tial fermentation.  "We  have  already  called  attention  to  the 
acids  which  come  directly  from  the  stomach  to  the  mouth 
in  cases  of  dyspepsia.  We  have  likewise  had  occasion  to 
remark  the  frequent  cases  of  caries  of  the  teeth  which  are 


PRODUCTION    OP    CARIES.  93 

met  with  in  persons  afflicted  with  diabetes  ;  they  are  attrib- 
uted to  the  sugar}'-  matters  which  the  saliva  contains,  and 
which  are  changed,  according  to  M.  Œhl,  into  lactic  acid. 

Nearly  all  observers  have  remarked  the  frequency  of  caries 
of  the  teeth  in  pregnant  females.  This  is  sufficiently  ac- 
counted for  by  the  troubles  which  they  experience  with  their 
digestion,  which  are  accompanied  by  the  formation  of  acids 
in  the  mouth  during  the  continuance  of  this  condition.  I 
think  it  is  not  necessary  to  find  here  any  analogy,  as  many 
observers  have  done,  with  the  osteomalacia^  sometimes  met 
with  in  pregnant  women.  There  are  seen,  it  is  true,  in  preg- 
nant women,  cases  of  osteomalacia^  which  must  be  caused  by 
their  state  of  pregnancy.  Cases  of  cure  of  this  malady  have 
been  recorded  where  it  had  aflected  the  pelvis,  and  which 
recurred  again  during  another  pregnancy,  to  be  again  cured 
after  delivery.  But  aside  from  the  extreme  rarity  of  these 
cases  it  is  not  proved,  it  is  not  even  probable,  that  the  calca- 
reous salts  of  the  dentine  can  be  taken  up  again  in  the  same 
manner  as  the  salts  of  the  bony  tissue  in  general  ;  we  must 
therefore  refuse  to  admit  such  an  explanation. 

If  we  recapitulate,  we  shall  find  in  the  work  of  fermenta- 
tion which  takes  place  in  the  mouth  a  continual  source  of 
acidity.  This  acidity,  by  its  action  on  the  teeth,  without 
doubt  acts  with  much  greater  energy  than  the  acids  formed 
transiently  by  the  alimentary  débris,  or  by  any  other  sub- 
stance introduced  into  the  mouth.  The  rôle  of  the  saliva  is 
here  to  change  into  sugar  the  starch  contained  in  the  food  ; 
moreover,  the  sugar  contains  fermentable  substances  which 
produce  an  acid  reaction.  I^evertheless,  the  saliva  dilutes 
and  neutralizes  the  acids,  when  it  exists  in  sufficient  quan- 
tity, and  thus  hinders  their  action  on  the  teeth.  We  cannot, 
then,  justify  the  assertion  of  M.  Magitot  that  the  saliva  is 
the  veritable  agent  of  caries  of  the  teeth.  He  contradicts 
himself,  adding,  in  the  same  phrase,  that  the  saliva  cannot 
produce  this  effect  when  it  retains  its  original  composition, 
but  only  in  consequence  of  certain  modifications  occasioned 
by  the  presence  of  injurious  substances  formed  spontaneously, 
or  introduced  from  without.     It  appears,  then,  evident  that 


94  INQUIRIES    INTO    DENTAL    CARIES. 

it  is  not  the  saliva,  but  rather  these  injurious  substances 
which  should  be  considered  as  the  agents  of  caries  of  the 
teeth. 

As  far  as  we  know,  the  veritable  nature  of  the  acids  found 
in  the  mouth  has  not  yet  been  demonstrated  by  any  direct 
experiment;  nevertheless,  it  is  generally  thought  to  be  lactic 
acid,  and  this  opinion  has  the  greatest  probabilities  in  its 
favor. 

As  a  general  rule,  it  is  lactic  acid  which  is  produced  by 
the  fermentation  of  sugared  liquids  and  others,  when  there 
are  present  at  the  same  time  albuminoid  substances.  This 
fermentation  is  particularly  favored  by  the  presence  of  the 
carbonate  of  lime,  which  neutralizes  the  acids  gradually  as 
the}^  are  formed  ;  whilst  the  fermentation  itself  is  hindered 
by  a  little  more  considerable  abundance  of  acids. 

Xow  all  these  conditions  are  fulfilled  in  the  buccal  cavity  ; 
the  saliva  and  the  mucus  contain  albumen,  and  carbonate  of 
lime  exists  in  great  quantity  in  tartar  and  the  dental  tissues. 
We  know  not  whether  or  not  there  are  formed  still  other 
acids.  We  might  expect  to  find  in  the  mouth  the  fun^i 
which,  according  to  M.  Pasteur,  should  accompany  and  pro- 
duce the  lactic  fermentation,  "ferment  de  l'acide  lactique  de 
Pasteur."  But  the  opinions  of  authors  upon  the  ferment  of 
lactic  acid  difler  so  greatly  that  it  is  impossible  for  us  to  at- 
tribute any  great  value  to  the  presence  of  this  ferment  in  the 
mouth.  According  to  M.  Pasteur  the  elements  of  the  ferment 
of  lactic  acid  are  molecular  corpuscles,  verj'  minute,  which  pre- 
sent a  very  marked  Brunonian  movement  whose  dimensions 
he  does  not  state  on  account  of  their  extreme  minuteness. 
In  the  work  of  one  of  his  pupils,  M.  Van  Tieghem,  upon  the 
fermentation  of  urine,  there  is  a  figure  of  one  of  these  fungi 
in  which  these  latter  are  contracted  in  the  middle  and  larger 
than  the  spores  of  the  urine  ferment  which  are  pictured  by 
their  side,  and  have  a  diameter  .0015  millimetre.  The  form 
of  these  fungi,  according  to  M.  Van  Tieghem,  is  identical 
with  that  of  the  mycoderma  aeeti  of  ^I.  Pasteur,  of  which  the 
diameter  is  likewise  .0015  millimetre.  This  figure,  then, 
does  not  at  all  agree  with  those  given  by  M.  Pasteur. 


PRODUCTION    OF    CARIES.  95 

The  observations  of  M.  Ilallier  upon  the  ferment  of  lactic 
acid  {oïdium  Ick-Hs,  Fresenius)  are  entirely  ditïerent  from 
those  of  M.  Pasteur.  According  to  him  the  elements  of  this 
ferment  consist  of  great  cells  of  a  rounded  quadrangular 
form  ;  they  should  be  constantly  found  in  the  acid  fermenta- 
tion of  milk,  and,  moreover,  upon  all  substances  in  a  state  of 
acid  fermentation. 

We  have  ourselves  found,  in  milk  soured  at  a  low  temper- 
ature, minute  corpuscles  endowed  with  power  of  very  rapid 
motion,  which  appeared  to  us  to  be  identical  with  those  de- 
scribed by  M.  Pasteur.  We  have  also  encountered  elements 
of  this  kind  in  saliva  containing  sugary  matters,  which  had 
passed  into  a  state  of  fermentation  ;  united,  these  elements 
presented  the  appearance  of  granular  masses  of  leptothrix, 
especiall}^  near  the  margins  of  the  preparation,  where,  in 
consequence  of  the  evaporation  of  the  liquid  portions,  their 
movements  had  been  arrested.  Nevertheless,  in  no  one  of 
these  cases  have  we  been  able  to  obtain  a  reaction  either 
with  iodine  or  with  the  acids. 

We  greatly  regret  that  there  are  so  few  methods  of  dis- 
tinguishing with  exactness  the  different  species  of  fungi,  and 
we  cannot  set  ourselves  the  task  of  undertaking  researches 
so  extensive,  and  demanding  so  much  time.  We  contine 
ourselves  in  consequence  to  presenting  some  observations 
upon  the  possil)le  coincidence  of  the  acid  fermentation  in 
the  mouth  with  the  presence  of  a  development  of  fungi. 

Besides  the  presence  of  a  great  quantity  of  leptothrix,  we 
see  in  the  mouth  but  a  very  small  number  of  spores  and  fila- 
ments of  a  fungus  which  bears  a  resemblance  to  oidium.. 
But  the  masses  of  leptothrix  are  so  predominant  that  we  are 
disposed  to  believe  in  their  participation.  If,  in  general,  the 
fungi  play  a  role  in  the  acid  fermentation  of  the  mouth, 
which  is  not  proved,  we  are  inclined  to  attribute  it  to  the 
leptothrix.  This  opinion  is  founded  upon  the  resemblance 
which  the  corpuscles  in  movement  during  the  fermentation 
of  the  saliva  and  of  milk  present  to  the  lactic  acid  ferment 
of  M.  Piisteur,  and  to  the  masses  of  leptothrix  which  are 
really  formed  in  the  mouth. 


96  INQUIRIES    INTO    DE-NTAL    CARIES. 

The  absence  of  the  violet  reaction,  so  characteristic,  which 
we  find  in  the  former  case,  depends  perhaps  upon  a  difi'erent 
degree  of  development. 

III.  Influence  of  Leptothrix  upon  the  Production  of 
Caries  of  the  Teeth. 

"We  have  already  several  times  remarked  that  the  action 
of  acids  alone  does  not  account  for  all  the  phenomena  which 
appear  in  caries  of  the  teeth.  It  is  true  that  acids,  even  very 
much  diluted,  can  attack  the  dental  tissues  ;  but  we  find,  in 
their  mode  of  action,  difierences  which  distinguish  them 
from  the  phenomena  and  from  the  j^rogress  of  dental  caries. 
The  acids  attack  first  the  enamel  and  rapidl}'  change  it  to  a 
chalky  mass  ;  later  only,  their  action  is  felt  in  a  marked 
manner  upon  the  dentine,  which  becomes  more  transparent 
and,  in  fine,  as  if  cartilaginous,  by  the  very  slow  but  pro- 
gressive loss  of  its  calcareous  salts. 

Caries,  on  the  contrary,  proceeds  slowly  in  the  enamel  ;  it 
is  much  swifter  in  the  dentine,  where  it  proceeds  promptly 
along  the  canaliculi.  This  difterence  of  progress  must  be  at- 
tributed to  the  participation  of  the  fungi  in  the  work  of  the 
caries.  The  elements  of  the  fungus  glide  easily  into  the  in- 
terior of  the  canaliculi,  which  they  dilate,  and  thus  favor 
the  passage  of  the  acids  into  the  deeper  parts  ;  these  same 
elements  cannot  penetrate  a  compact  enamel,  or  at  least  they 
enter  more  slowly,  and  only  when  the  elements  which  form 
it  have  been  greatly  changed  by  the  action  of  acids. 

Leptothrix  is  found  almost  constantly  in  the  buccal  cavity, 
if  great  care  is  not  taken  to  rinse  the  mouth  frequentl}^ 
Mr.  Bowditch,  in  examining  forty  persons  of  difi'erent  pro- 
fessions, and  living  difterent  kinds  of  life,  found  in  almost 
all  vegetable  and  animal  parasites.  Those  only  were  found 
to  be  free  who  cleaned  their  teeth  several  times  a  day,  and 
at  least  once  with  soap.  The  parasites  were  numerous  in 
proportion  to  the  neglect  of  cleanliness.  The  means  ordina- 
rily employed  to  clean  the  teeth  had  no  efiect  upon  these 
parasites,  whilst  soap  appeared  to  destroy  them. 


PRODUCTION    OF    CARIES.  97 

M.  Kolliker,  out  of  twenty  to  thirty  young  and  well  per- 
sons, found  hardly  one  the  papillœ  of  whose  tongue  was  free 
from  a  grayish  and  granular  coating;  he  more  rarely  met 
with  filaments  of  the  fungus.  It  is  true  that  regard  must 
be  had  to  the  hour  of  the  day  at  which  the  examinations 
were  made  ;  it  is  natural  that  all  these  matters  should  always 
be  more  abundant  when  the  individual  is  fasting. 

But,  while  in  ordinary  circumstances,  the  fungi  are  found 
only  at  the  surface  of  the  buccal  cavity,  they  are  seen  to 
penetrate  into  the  interior  of  teeth  during  the  progress  of 
caries.  For  them  to  be  able  to  penetrate  thus  it  is  necessary 
that  the  teeth  be  in  a  suitable  condition;  the  enamel  and 
the  dentine  must  have  lost  their  density  by  the  action  of 
acids. 

It  seems  that  the  fungi  are  not  able  to  penetrate  an  enamel 
of  normal  consistency.  The  dentine  itself,  in  its  normal  con- 
dition of  density,  oflers  great  difficulties  to  their  entrance, 
and  we  are  not  yet  sure  that  the  leptothrix  could  triumph 
over  this  resistance.  We  do  not  speak  here  of  the  greenish 
deposit  found  upon  teeth,  which  difters  from  caries,  and  upon 
which' we  have  not  yet  sufficiently  experimented.  It  may 
happen  that,  under  favor  of  this  deposit,  fungi  may  penetrate 
into  the  superficial  layers  of  the  enamel,  which  does  not 
appear  to  be  the  case  in  ordinary  caries.  Habitually  the 
teeth  expose  to  the  action  of  injurious  agents  only  their 
crowns  covered  with  enamel,  and  this  protects  them  from 
the  attacks  of  the  fungus.  We  cannot  decide,  at  present,  if 
the  leptothrix  is  able  to  penetrate  sound  dentine,  when  from 
any  abnormal  circumstance  it  happens  to  be  denuded.  But 
if  the  enamel  or  the  dentine  are  become  less  resistant  at  any 
point  through  the  action  of  acids  ;  or  if,  at  the  surface  of 
the  dentine,  a  loss  of  substance  has  occurred,  then  the  ele- 
ments of  the  fungus  can  pass  into  the  interior  of  the  dental 
tissues,  and  produce  by  their  extension,  especially  in  the  den- 
tine, efiects  of  softening  and  destruction  much  more  rapid 
than  the  action  of  acids  alone  is  able  to  accomplish. 

The  participation  of  the  fungus  is  constant  in  the  progress 
of  caries  which  has  reached  this  stage.     As  soon  as  a  loss  of 


98  INQUIRIES    INTO    DENTAL    CARIES. 

substance  can  l)e  shown  there  is  found  thcpresence  of  the 
fungus,  so  tliat  the  question  whether  or  no  the  acids  alone 
could  produce  ravages  more  considerable  is  without  impor- 
tance. But  in  the  early  stage,  w^hen  the  surface  of  the  tooth 
is  still  polished  and  intact,  we  have  never  been  able  to  prove 
the  presence  of  the  fungus  ;  it  appears,  therefore,  that  at  this 
stage  of  the  malady,  which  constitutes  the  dry  caries,  prop- 
erly so  called,  all  the  disorders  must  be  attributed  to  the  sole 
action  of  acids. 

The  development  of  the  fungus  seems  to  be  favored  by  a 
neutral  or  slightly  acid  medium,  whilst  it  cannot  flourish  in 
a  strongly  alkaline  liquid.  We  have  already  called  attention 
to  the  observation  of  Dr.  Bowditch,  who  has  seen  the  para- 
sites disappear  upon  rinsing  the  mouth  with  a  solution  of 
soap.  M.  A.  Vogel  found  that  the  fungus,  oidium  albicans^ 
continued  to  develop  in  pure  water,  in  solutions  of  salts  with- 
out alkaline  reaction,  and  especially  in  solutions  of  sugar; 
whilst  no  proliferation  could  take  place  in  solutions  slightly 
alkaline.  These  observations,  to  judge  of  them  by  analogy, 
seem  likewise  to  prove  that  alkaline  liquids  may  exercise  a 
destructive  action  upon  the  leptotlirlx. 

IV.  Therapeutic  Conclusions. 

It  is  not  without  importance  to  cast  an  eye,  before  con- 
cluding, upon  the  therapeutic  conclusions  which  should  be 
drawn  from  the  results  -which  we  have  reached,  and  to  see 
if  they  are  in  accord  with  the  experience  of  practitioners. 

Before  all,  as  regards  the  prophylactic  indications,  it  can 
be  said  that  we  should  seek  to  neutralize  the  acids  which 
form  in  the  mouth,  and  to  prevent  all  work  of  fermentation 
and  of  development  of  fungi  by  proper  care  for  cleanliness. 
Teeth  well  formed  may  be  spared  by  caries  in  spite  of  the 
greatest  negligence;  but  we  should  take  the  greater  care  of 
our  teeth  in  proportion  as  they  are  badly  developed  or  irregu- 
larly arranged.  With  great  care  even  malformed  teeth  may 
be  preserved  from  caries.  In  cleaning  the  teeth  such  brushes 
should  be  used  as  are  not  too  hard,  and  which,  by  a  slight 


THERAPEUTIC    CONCLUSIONS.  99 

pressure,  can  be  made  to  enter  the  spaces  between  the  teeth. 
We  may  advise,  as  useful  for  this  purpose,  the  emploj-ment 
of  soap,  which,  by  imparting  a  slightly  alkaline  quality  to 
"the  Avater,  neutralizes  the  acids  and  hinders  the  development 
of  fungi.* 

In  many  cases  the  soap  does  not  suffice  to  remove  entirely 
tlie  deposit  formed  upon  the  teeth  ;  in  such  case  there  should 
be  added  to  it  powders  which  act  mechanically,  but  care 
should  be  taken  that  they  are  not  too  gritty  ;  the  disagree- 
able taste  of  soap  may  be  easily  corrected. 

We  can  also  recommend  the  permanganate  of  potassa  dis- 
solved in  water  as  an  excellent  mouth  wash,  inasmuch  as 
this  remedy  is  a  very  excellent  antiseptic,  and  at  the  same 
time  the  best  means  of  preventing  fermentation;  this  water 
exercises  a  beneficial  action  upon  the  mucous  membrane  of 
the  mouth. 

As  regards  the  artificial  treatment  of  caries  our  observa- 
tions are  at  every  point  in  accordance  with  the  experiments 
made  up  to  this  time.  In  filling  the  teeth  the  air  and  liquids 
are  hindered  from  penetrating,  and  all  work  of  fermentation, 
and  all  development  of  fungi,  become  impossible. 

There  has  appeared  lately  in  the  Archives  of  Virchoio,  vol. 
xli,  an  article  by  Dr.  Hertz  upon  "Dental  Caries."  This 
author,  having  no  knowledge  of  our  experiments,  has  not 
discussed  our  opinions,  although  his  mémoire  appeared  some 
time  after  ours.  In  a  note  added  to  the  end  of  his  work  he 
wrongly  accuses  us  of  rejecting  all  vital  action  of  the  den- 
tine in  the  production  of  caries. 

As  for  the  rest,  the  opinions  of  Hertz  are  nearly  in  agree- 
ment with  those  of  jSTeumann.  He  asserts  that  he  has  never 
observed  alteration  of  dentinal  fibrils  in  natural  teeth  of 
substitution,  ^^^e  maintain  the  correctness  of  our  observa- 
tions on  this  subject.  It  only  remains  to  determine  if  the 
alterations  we  have  described  are  constant,  or  if  they  are 
wanting  in  certain  cases. 

*  T'/f/c  J.  B.  Kotteristein.  Des  soins  à  donner  aux  dents.  Frankfort-sur- 
le-Maine,  1857. 


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EXPLANATIOIT  OF  THE  PLATES. 


PLATE  I. 

Fig.  1.   (Magnified  three  diameters.) 

Longitudinal  section  of  a  carious  bicuspid.  The  section  is  slightly  slanted 
across  a  large  carious  cavity  ;  upon  the  left  side  of  the  crown  a  cone  of  a 
dark  color  is  seen  in  the  dentine  altered  by  caries  ;  this  cone  extends  in  the 
direction  of  the  dentinal  canals  from  the  surface  even  to  the  pulp-cavity,  and 
presents  a  radiated  striation  which  corresponds  to  these  canals.  Upon  the 
surface  of  the  section  the  loss  of  substance  extends  only  upon  the  enamel, 
whilst  upon  the  neighboring  parts  it  penetrates  deeply  into  the  interior  of 
the  dentine.  Upon  the  masticating  surface  of  the  enamel  are  seen  two 
fissures. 

Fig.  2.   (Magnified  three  diameters.) 

A  longitudinal  section  of  a  canine  tooth  with  commencing  caries.  In  the 
centre  of  the  crown  is  a  small  carious  point  in  a  depression  of  the  enamel  ;  the 
caries  has  not  as  j^et  attacked  more  than  a  superficial  layer  of  the  enamel. 
A  similar  point  exists  at  the  left  side  of  the  crown,  also  without  loss  of  sub- 
stance, and  it  is  from  this  point  that  the  caries  has  extended  across  the  whole 
thickness  of  the  enamel,  and  nearly  across  the  whole  thickness  of  the  dentine 
to  the  neighborhood  of  the  pulp-cavity. 

The  outermost  layers  of  the  dentine  are  of  a  darker  color  than  the  deepest 
layers  of  the  enamel,  the  color  diminishing  in  both  from  the  surface  inwards. 
There  are,  moreover,  three  small  carious  cavities  which  reach  to  the  surface 
of  the  dentine;  also  cones  of  carious  dentine  are  seen  to  start  from  these 
cavities  and  point  to  the  pulp-cavity;  one  of  these  cavities  exists  at  the  right 
side  of  the  crown,  the  two  others  are  found  at  the  neck  of  the  tooth. 

Fig.  3.  (Magnified  three  diameters.) 

Section  of  a  human  molar  with  caries  commencing.  In  the  middle  of  the 
crown  a  loss  of  substance  in  the  enamel  (the  enamel  has  been  broken  away 
at  the  sides  in  the  process  of  preparation)  ;  in  the  dentine  a  cone  of  a  clear 
color  altered  by  caries  ;  this  clear  color  is  due  to  the  transparency  of  the 


102  EXPLANATION    OF    THE    PLATES.  - 

tissue  ;  the  brownish  color  cannot  be  perceived  on  account  of  the  thinness  of 
the  specimen. 

Fig.  4. 

A  fragment  of  this  same  section  magnified  one  hundred  diameters.  A 
very  thin  hiyer  of  enamel  is  seen  on  a  level  with  the  loss  of  substance;  the 
most  superficial  layers  are  very  transparent  in  consequence  of  the  disappear- 
ance of  the  calcareous  salts.  It  is  seen,  also,  that  the  surface  is  irregular  and 
covered  with  fissures  and  cracks.  The  layer  of  leptothrix  is  not  preserved  at 
the  surface,  but  there  exist  at  one  point  masses  of  granular  leptothrix  which 
have  penetrated  the  dentine  across  a  fissure  of  the  enamel.  The  outer  layers 
of  dentine  are  dark  and  the  canals  more  difficult  to  distinguish  ;  in  the  deeper 
layers  are  found  little  deposits  of  calcareous  salts  in  the  canals  and  inter- 
globular spaces. 


PLATE  II. 


Fig.  1.   (Magnified  one  hundred  times.) 

Section  of  the  surface  of  a  carious  cavity.  The  dentine  is  reduced  to  frag- 
ments enveloped  with  leptothrix.  On  the  free  surface  delicate  filaments  of 
the  fungus  are  seen  crossinij;  the  granular  masses. 


Fig.  2.  (Magnified  one  hundred  times.) 

The  decomposition  of  the  dentine  has  made  still  greater  progress.  The 
débris  are  much  smaller  and  less  voluminous  than  the  masses  of  leptothrix 
which  surround  them. 

Fig.  3.  (Magnified  one  hundred  times.) 

Transverse  section  made  at  the  surface  of  a  cavity  across  the  carious  den- 
tine. The  dentinal  canals  are  greatly  thickened  (which  is  difficult  to  observe 
in  the  longitudinal  section  of  Figs.  1  and  2)  ;  at  the  surface  is  a  thick  layer 
of  very  fine  filaments  of  leptothrix. 


Fig.  4.   (Magnified  two  hundred  and  fifty  times.) 

Transvei-se  section  of  an  artificial  human  tooth  attacked  by  caries.  The 
changes  are  identical  with  those  of  the  natural  teeth.  The  canals  are  more 
or  less  dilated;  some  are  considerably  so  and  have  thickened  walls,  that 
which  could  not  be  distinguished  upon  those  of  the  canals  which  were  the 
most  thickened. 


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20ty 


£>/?  /£S£/i  FROM  NAT  UREJJEl 


T.  SINCLAIR  3 SON  UTH.PHW- 


EXPLANATION    OP    THE    PLATES.  103 


Fig.  5.   (Magnified  two  hundred  and  fifty  times.) 

Canals  isolated  by  hydrochloric  acid,  and  coming  from  the  carious  dentine 
of  man.  These  canals  show  various  degrees  of  thickening;  their  contents 
are  divided  in  the  form  of  little  bundles.  In  a  a  minute  canal  is  seen  greatly 
dilated,  from  which  spring  several  undilated  ramifications  which  are  de- 
tached near  their  point  of  origin  by  the  act  of  preparation.  In  b  two  small 
tubes  very  slightly  dilated,  one  of  which  becomes  gradually  thicker. 

Fig.  6.  (Magnified  two  hundred  times.) 

Transverse  section  of  a  carious  tooth,  one  made  of  hippopotamus  ivory. 
A  layer  of  leptoihrix  at  the  surface;  similar  masses  penetrate  (in  a),  pro- 
ceeding from  the  surface,  into  the  interior  of  the  tissue  (in  b)  ;  they  seem 
separate  from  the  surface,  because  they  have  been  crushed  obliquely  by  the 
section.  The  dentinal  canals  are  for  the  most  part  dilated  (c)  ;  some  of  them 
still  present  the  normal  state  {d). 

Fig.  7.   (Magnified  two  hundred  and  fifty  times.) 

Canals  of  the  same  tooth  (hippopotamus)  greatly  dilated  and  presenting 
varicose  sinuosities.  At  the  right  some  of  them  are  still  united  by  very  fine 
fibrils,  wjiich  appear  to  be  the  residue  of  the  dentine. 


CATALOGUE 

OF  THE 

PUBLICATION'S 

OP 

Lindsay  &  Blakiston, 

INCLUDING  WORKS  ON 
The  Practice  of  Medicine,    {  Diseases  of  "Women, 


Surgery, 
Anatomy, 
Physiology, 
Materia  Medica, 
Ophthalmoscopy, 
Therapeutics, 

AND 


Diseases  of  Children, 
Obstetrics, 
Pathology, 
Chemistry, 
Pharmacy, 
Dentistry, 


THE  COLLATERAL  SCIENCES. 

ALSO, 

PHYSIOLOGICAL,  ANATOMICAL,  AND 

OBSTETRICAL  MAPS  AND  DIAGRAMS, 

THE  SYDENHAM  SOCIETY'S  PUBLICATIONS, 

PHYSICIANS'  VISITING  LISTS, 

&c.,   &c. 


Any  of  the  books  in  this  Catalogue  can  be  had  at  the  prices  annexed, 

from  or  through  the  principal  Booksellers  in  the  United  States 

and  Canada;  or  they  will  be  sent  free  by  mail  to  persons  who 

cannot  obtain  them  otherwise,  upon  the  receipt  of  the  amount  by 

the  Publishers,  „   _^   .  ^^^^^^^^ 

'  LINDSAY  &  BLAKISTON. 

Phii-ahelphia,  *  I^o.  25  South  Si.rfh  Street, 

December,  1872.  PHILADELPHIA. 


Ts^EW  BOOKS  AND  NEW  EDITIONS, 
Published  by  LINDSAY  &  BLAKISTON,  Philadelphia. 

NOW    READY. 
Aitkin's  Science  and  Practice  of  Medicine.      Third  American,  from  tb* 

Sixth  London  Edition.     Thoroughly  Revised,  Remodelled,  and  partially  rewritteu, 

with  many  New  Illustrations.     2  vols.,  Royal  Octavo. 
Heu-ift's  Diagnosis,  Patïtology,  and  Treatment  of  the  Diseases  of 

IVoïnen,     The  Third  Enlarged  Edition. 
litack's  Functional  Diseases  of  the  Urinary,  Renal,  and  Reproduce 

five  Orf/ans. 
Harlcy.     The  Urine  and  its  Derangements.    With  Illustrations. 
Hewson.    Earth  as  a  Topical  Application  in  Surgery.     Illustrated. 
Physicians'  Visiting  List  for  187 S.     Various  sizes,  styles,  and  prices. 
Wedl.     The  Pathology  of  the  Teeth.     Illustrated. 
Leivin  oftthe  Treatment  of  Sypliilis.     With  Illustrations. 
Peasley's  Book  of  3000  Prescrijjtions.     The  Fourth  Revised  Edition. 
Beale.     Disease  Germs.     Second  Edition,  much  enlarged,  with  a  Isew  Part  on 

the   Distribution  of  Disease  Germs,  and  28  Plates,  many  of  them  colored. 
Rindfleisch's  Text-book  of  Pof/iological  Histology.     Illustrated. 
Jleadows'  New  TexA-book  of  Obstetrics.     Second  Edition.     Illustrated. 
Tanner's  Mauiiat  of  Poisons.     A  New  Enlarged  Edition. 
Rf>ss.     The  Graft  Theory  of  JDiscase. 

Dloxant's  Chemistry,  Inorganic  and  Organic.     Second  Edition. 
Cooley.     Cyclopedia  of  Receipts.     Fifth  London  Edition,  much  enlarged. 
Take.    Illustrations  of  the  In/iuence  of  the  Mind  ou  the  Body. 
Dobell.      Winte}-  Cough.     New  Edition.     Colored  Illustrations. 
Arnott  on  Cancer.     With  Illustrations. 
Elain.     On  Cerebra  and  other  Diseases  of  the  Brain. 
Ward,     On  some  Affections  of  the  Liver  and  Intestinal  Canal. 
Legg,     The  Eratni nation  of  the  Urine.     Third  Edition. 
Mackenzie.     On  Earynge<d  Growttis.     Colored  Illustrations. 

"  Pharmaropœia  of  the  Hospital  foi'  Diseases  of  the  Throat, 

Reynold's  Clinical  Uses  of  Electricity. 
Rigby's  Obstetric  Memoi-anda.     Fourth  Edition. 
Gant's  Irritable  Bladder.     Third  Edition. 
Habershon  on  Diseases  of  the  Liver. 

Martin's  Manual  of  Microscopic  Mounting,     With  Illustrations. 
Atthill's  Clinical  Lectures  on  tlie  Diseases  of  Women.     Second  Edition, 

Enlarged  and  Illustrated. 
Fothergill  on  Diseases  of  the  Heart,  and  their  Treatment. 
Trousseau's  Clinical  Lectures,     Vol.  5,  completing  the  work. 
Macnamara  on  Diseases  of  the  Eye.     Second  Edition.    Enlarged. 

IN    PREPARATION. 
Sanderson  and  Foster's  Hand-book  for  the  Laboratory. 

Swevingen's  Pharmaceutical  Lexicon. 

Coles.    Dental  3Iechanics.     Illustrated. 

Tibbitt's  Hand-Book  of  Medical  Electricity,    With  Illustrations. 

Thoj'owgood's  Notes  on  Asthma.     Second  Edition. 

Allingham  on  the  Rectum,  Sc.     Second  Edition. 

Fuller  on  Rheumatism,  li-c.     A  New  Edition. 

3Iaunder's  Operative  Surgery.     Second  Edition. 

Tomes'  Dental  Surgery.     A  New  Enlarged  Edition. 

Walton  on  the  Eye.     From  the  Th'ird  London  Edition. 

Hardwick's  Photographic  Chemistry.     Eighth  Edition. 

Roberts'  Hand-Book  of  the  Practice  of  Medicine, 

^^  For  particulars,  see  under  alphajaelical  arrangement,  in  Catalogue. 


St  *, 

LINDSAY   AND   BLAKISTON'S    PUBLICATIONS. 

"The  Representative  Book  of  Medical  Science."  —  London  Lancet. 

Aitken's  Science  and  Practice  of  Medicine. 

THIRD  AMERICAN,  FROM  THE  SIXTH  LONDON  EDITION. 
rnoROUOiiLY  revised,  remodelled,   many   portions   rewritten,   with 

ADDITIONS     EQUAL    ALMOST    TO    A    THIRD    VOLUME,    AND    NU- 
MEROUS  ADDITIONAL    ILLUSTRATIONS,    WITHOUT 
ANY  INCREASE  IN    BULK  OR  PRICE. 

The  Science  and  Practice  of  Medicine.  By  William  Aitken,  M.D.,  Pro- 
fessor of  Pathology  in  the  Army  Medical  School,  éc,  &c.  The  Third 
American,  from  the  Sixth  London  Edition,  edited  with  Additions  De 
scriptive  of  Certain  Forms  and  Types  of  Disease  peculiar  to  this 
Country,  and  their  Modes  of  Treatment,  by  Meredith  Clymer,  M.D  , 
ex-Professor  of  the  Institutes  and  Practice  of  Medicine  in  the  Uiiiversity 
of  New  York,  ^ecturer  on  the  Diseases  of  the  Nervous  System  and 
of  the  Mind  in  the  Albany  Medical  College,  &c.  In  Two  Yolumes 
Royal  Octavo.  With  a  Colored  Map,  a  Lithographic  Plate,  and  nearly 
Two  Hundred  Illustrations  on  Wood. 

Price,  bound  in  Cloth,  bevelled  boards,    ....         $12.00' 
Leather, 14.00 

Tor  eighteen  months  Dr.  Aitken  haa  been  engaged  in  again  carefully  revising  this  Great  Work,  and  adding 
to  it  many  valuable  additions  and  improvements,  amounting  in  the  aggregate  almost  to  a  volume  of  new 
■matter,  included  in  which  will  be  found  the  adoption  and  incorporation  in  the  text  of  the  "  netv  nomenclature 
of  the  Royal  College  of  I'liysiciaiis  of  London  ;  "  to  which  are  added  the  Définitions  and  tlie  Foreign  e<iuivalent8- 
for  their  English  names;  tlie  New  Clivssification  of  Disease  as  adopted  by  the  Royal  College  of  Physicians,  &c. 

Dr.  Aitke.n's  Practice  is,  by  almost  universal  consent,  both  in  England  and  the  United  States,  acknowl- 
edged to  be  in  advance  ot  all  other  works  on  "'/lie  Science  mid  Pi'actice  of  Medicine."  It  is  a  moat  thorough 
and  complete  Text-book  for  students  of  medicine,  following  such  a  systematic  arrangement  as  ■nili  give  them 
a  consistent  view  of  the  main  facts,  doctrines,  and  jiractice  of  medicine,  in  accordance  with  accurate  physio- 
logical and  pathological  principles  and  the  present  state  of  science.  For  the  practitioner  it  will  be  found 
equally  accepta-ble  as  a  work  of  reference. 

The  author's  plan  has  been  carried  out  to  that  perfection  that  the  treatise  is  as  complete  a  one  a»  can  be  • 
found  in  any  language.  Every  department  of  medicine,  whether  relating  to  pathology,  nosology,  diagnosis,  . 
or  treatment,  is  most  elaborately  and  thoroughly  discussed.  The  editor,  Dr.  Meredilh  Clymer,  ha»  coatrib- 
uted  his  share  to  the  work  by  many  judicious  additions  to  the  original  text,  which  makes  the  work  particu- 
larly valuable  to  the  American  practitioner.  As  a  whole,  it  now  forms  a  complete  cyclupa'dia  of  medicine^, 
and  commends  itself  to  those  practitioners  and  students  who  have  a  desire  to  perfect  their  knowledge  of  our  ; 
wt,  and  gain  much  of  that  information  which  is  crowded  out  of  the  smaller  text-books. 

iV.  r.  Medkal  Eecurd. 

It  must  now  be  looked  upon  as  the  standard  text-hook  in  the  English  language. 

Edinhsrgh.  Medieeil  Jowrnal. 

All  the  light  which  recent  advances  have  made  in  the  method  of  examining,  diagnosing,  and  treating  of  ■ 
âiBoases  are  here  imparted.  British  and  Foreitjn  iledieo-Odrurgieul  JSeview. 

It  forms  the  latest  and  most  scientific  vjork  on  medicine  yet  published.        London  Mediaal  Time»  axid  Gazette. 

It  is  the  most  comprehensive  work  that  has  ever  been  published  on  the  Practice  of  Medicine. 

British  Medical  Journal. 

By  the  student  tt  will  bo  found  to  be  the  most  useful  and  coi»p»»hensive  text-hook  extant. 

Glasgovi  Medical  Jyumai. 

The  great  merit  of  this  work  of  Dr.  Aitken's  is,  that  it  treats  the  various  forms  of  disease  according  (c 
%  scientific  classification.  Atfi,enieum. 

Dr.  Aitken's  work  at  once  took  the  first  place  among  text-books,  and  will  hold  that  position  for  years  to 
come.  Medical  Mirror. 

Dr.  Aitken's  work  is  an  admirable  one  for  the  student  and  busy  practitioner.    A  more  excellent  one  we. 
really  do  not  know.  London  Lancet,  May  13, 1865. 

In  Dr.  Aitkei."B  book,  diseases  are  described  which  have  hitherto  found  no  place  in  any  English  systen^ 
•  Rework.  WMiminsie}   Uevi«w^ 


New  Book  on  Diseases  of  Women. 

SECOND  EDITION,  REVISED  AND  ENLARGED. 

Atthill's  Clinical  Lectures  on  Diseases  Pecul- 
iar to  Women.  Bj  Lombe  Atthill,  M.D.,  Fellow  and 
Examiner  in  Midwifery,  King  and  Queen^s  College  of  Physicians: 
OhMetric  Physician  to  the  Adelaide  Hospital,  and  formej'ly  Assistant 
Physician  to  the  Rotundo  Lying-in  Hospital.  Demy  Octavo,  with 
Illustrations.     Now  Ready.  Price,  32.25 

"  This  excellent  little  book  has  three  great  merits.  It  treats  of  very  common  diseases 
which  are  generally  very  badly  taught  in  our  Schools.  Secondly,  it  treats  of  them  in 
a  thoroughly  clinical  and  practical  way  ;  and  finally,  without  being  too  short,  is  a 
compact  book,  calculated  to  be  very  useful  to  the  practitioner.  Dr.  AtthilTs  practice, 
if  not  original,  is  thoroughly  independent,  and  he  illustrates  it  \ùih.  a  copious  quota- 
tion of  good  cases.  We  commend  the  whole  book  to  the  careful  attention  of  advanced 
students  and  general  practitioners." — Lance/,March  23,  1872. 

"  The  lectures  before  us  have  the  merit  of  calling  attention  to  this  important  subject 
with  the  voice  of  personal  experience.  Those  on  Menorrhagia,  endo-Metritis,  and 
endo-Cervicitis,  we  would  specially  point  out  as  worthy  of  note  ;  and,  without  endors- 
ing the  author's  therapeutic  treatment  of  those  ali'ections,  we  cannot  but  admire  the 
clearness  of  style  and  practical  character  of  their  literary  treatment."  —  Glasgow 
Medical  Journal,  May,  1872. 

"  Tliese  lectures  form  an  admirable  text-book  for  students.  Dr.  Atthill,  as  Examiner 
in  the  Queen's  University  and  College  of  Physicians  of  Ireland,  discovered  the  utter 
ignorance  of  the  majority  of  students  on  the  important  subject  of  Diseases  Peculiar  to 
Women.  The  publication  of  this  little  volume  supplies  a  want  that  has  long  been  felt 
by  students  preparing  for  examination.  In  these  lectures  is  to  be  found  a  clear  and 
concise  summary  of  the  clinical  practice  of  the  diseases  peculiar  to  women.  The  work 
is  the  result  of  large  and  accurate  Qlinical  observation,  recorded  in  an  admirably  terse  and 
perspicuous  stj'le,  and  is  remarkable  for  the  best  qualities  of  a  practical  guide  to  the 
student  and  practitioner."  —  British  Medical  Journal,  May  11,  1872. 

"  A  most  excellent  though  brief  hand-book  on  the  Diseases  Peculiar  to  Women  ;  one 
that  cannot  fail  to  be  of  great  use  to  students,  and  that  will  guide  them  to  a  right 
understanding  of  the  cases  brought  before  them  in  their  hospital  practice.  Nor  is 
this  all;  to  the  busy  practitioner  this  book  will  be  of  use  in  many  an  emergency,  not 
only  assisting  him  in  the  recognition  of  the  various  forms  of  disease  most  frequently 
met  with,  but  also  forming  a  safe  and  reliable  guide  to  their  treatment  on  sound  and 
scientific  principles.  We  think  Dr.  Atthill  has  done  good  service  in  publishing  his 
lectures,  and  we  strongly  recommend  them  to  the  careful  and  attentive  perusal  of  all 
who  wish  to  study  the  diseases  of  women."  —  Dublin  Journal  of  Medical  Science,  Novem- 
ber, 1871. 

"A  very  useful  and  judiciously  written  work." — British  and  Foreign  Medico- Chirur- 
gical Review,  April,  1872. 

"  D'-.  .Vttliill  has  done  good  service  by  giving  to  the  world  a  concise,  lucid,  and  inex- 
pensive treatise  on  the  more  commonly  met  with  forms  of  Uterine  disease.  We  cannot 
conclude  witliout  expressing  our  surprise  and  gratification  that  so  much  valuable 
information  has  been  condensed  into  so  small  a  compass." —  The  Medical  Press  and  Cir- 
cnliir,  November  15,  1871. 

"The  author  has  compressed  jp^  a  small  work  a  large  amount  of  information  of  the 
most  u.seful  kind.  The  lectured  are  strictly  clinical,  and  the  conciseness  with  which 
Ur.  Attliill  discusses  his  sutjjects  will  make  the  work  a  favorite  with  general  practi- 
tioners, and  this  it  deserves  to  be." —  The  Doctor,  April  1,  1872. 

ArnOtt   on    Cancer,   itsVarieties,th.eir  Histology  and  Diagnosis 
By  Henky  Arnott,  F.R.C.S.,  Assistant  Sur^geon  to  St.  Thomas'  Hos- 
pital.    Illustrated  by  Five  Lithographic  plates  and  Tioenty-two  Wood 
Engravings,  drawn  from  Nature.     Octavo.     Price,    .         .  $2  25 


LINDSAY   AND   BLAKISTON'S   PUBLICATIONS. 

Allingliam  on  Fistula,  Haemorrhoids,  Painful 

Ulcer,  Stricture,  Prolapsus,  and  other  Diseases  of 
the  Rectum,  their  Diagnosis  and  Treatment.  By  William  Allino- 
HAM,  Fellow  of  the  Royal  College  of  Suri/eous  of  E»gla)id,  Surgeon 
to  St.  Mark^s  Hospital  for  Fidula,  &c.     New  p]dition  preparing. 

The  Medical  Press  and  Circular,  spenkin^  of  this  book,  says:  "No  book  on  this  special  subject  that  can  at 
til  approach  Mr.  AUingham's  in  precision,  clearness,  and  practical  good  sense  " 

Anil  T/ie  Lniidon  Lancet:  —  "As  a  practical  guide  to  the  treatment  of  affections  of  the  lower  bowel,  this 
book  is  worthy  ol  all  couimepidatiou." 

Adams  on  Club-Foot. 

Its  Causes,  Pathology,  and  Treatment.  Being  the  Jacksonian  Prix 
Essay  for  1864.  By  William  Adams,  F.R.C.S.,  Surgeon  to  the  Royal 
Orlhopdedic  and  Great  Nortliern  Hospitals.  A  New'  Edition,  with 
Numerous  Illustrations.     In  preparation. 

Adams  on  Rheumatic  and  Strumous  Diseases 

Of  tiik  Joints  ;  including  Hip- Joint  Disease,  and  the  Treatment  for 
the  Restoration  of  Alotion  in  Cases  of  Stiff-Joint  or  Partial  Anchylo- 
sis. The  Lettsoniian  Lectures  delivered  before  the  Medical  Society 
of  London  in  1869.     In  preparation. 

Acton  on  the  Functions  and  Disorders  of  the 
Reproductive  Organs,     new  edition. 

In  Childhood,  Youth,  Adult  Age,  and  Advanced  Life,  considered  in  their 
Physiological,  Social,  and  Moral  Relations.  By  "^N'illiam  Acton,  M.R. 
C.  S.,  etc.  Third  American  from  the  Fifth  London  Edition.  Care- 
fully revised  by  the  author,  with  additions.    Just  Ready,  octavo,  $3.00 

To  such  of  our  readers  as  are  not  familiar  with  Acton's  book,  we  may  say  that  his  plan  embraces  the  con- 
lideration  of  topics  of  great  interest:  such  as  are  peculiar  to  childhood,  embracing  its  vices;  those  peculiar 
to  precocity  and  included  in  masturbation  ;  similar  iui|uiries  pertaining  to  youth  and  iuliilt  age,  and  so  on 
through  the  stages  of  life  with  its  inquiries.  Indeed,  we  may  say  that  all  those  delicate  matters  pertaining 
to  the  male  sexual  conditions  are  treated  in  this  volume  with  singular  care  and  intelligence.  —  Lancet  atid 
Obsercer,  October,  1871.    • 

Anstie  on  Stimulants  and  Narcotics. 

Their  Mutual  Relations,  with  Special  Researches  on  the  Action  of  Alcohol, 
Ether,  and  Chloroform  on  the  Vital  Organism.  By  Francis  E.  Anstie, 
M.D.,  Assistant  Fhyéician  to  Westnmister  Hospital,  Lecturer  on  Matenia 
Medica  and  Therapeutics,  etc.,  etc.     Octavo,   .         .         .  $3,00 

A.ithaus'  Medical  Electricity.     4  xtw  u.avery  much 

Enlarged  Edition. 
A  Theoretical  and  Practical  Treatise,  and  its  Use  in  the  Treatment  of 
Paralysis,  Neuralgia,  and  otlter  Diseases.  By  Julius  Altiiaus, 
M.  D.,  Member  of  the  Royal  College  of  Physicians,  &c.  Second 
Edition,  revised,  enlarged,  and  for  the  most  part  rewritte,n.  In  One 
Volume  Octavo,  with  a  Lithographic  P.ate  and  tn.rty-'.>co  Illustrations 
nn  Wood      Price,  ...  .  .         .         85.00 


LINDSAY   AND    BLAKISTON's   PUBLICATIONS. 


Byford's  Practice  of  Medicine  and  Surgery. 

Applied  to  the  Diaeasen  and  Accidents  Incident  to  Women.     By  W.  H. 
Byford,  A.m.,  M.D.,  Professor  of  Obstetrics  and  Diseases  of  Women 
and  Children  in  the  Chicago  Medical  College,  &c.,  &c.     Second  Edi- 
tion, Revised  and  Enlarged.     Octavo.  ....         $5.00 
This  work  treats  well-nigh  all  the  dise.ases  incident  to  women,  diseases  and  accidents 
of  the  vulva  and  perineum,  stone  in  the  bladder,  inflammation  of  the  vagina,  menstru- 
ation and  its  disorders,  the  uterus  and  its  ailments,  ovarian  tumors,  diseases  of  the 
mammœ,   puerperal   convulsions,    phlegmasia   alba  dolens,   puerperal   fever,    &c.     Its 
scope  is  thus  of  the  most  extended  character,  yet  the  observations  are  concise,  but 
convey  much  practical  information.  —  London  Lancet. 

Byford  on  the  Uterus,  second  edition,  now  Ready. 

On  the  Chronic  Inflammation  and  Displacement  of  the  Unimpregnated 
Uterus.     A  New,  Enlarged,  and  Thoroughly  Revised  Edition,  with 
Numerous  Illustrations.     Octavo.         .....         $3.00 

Dr.  Byford  writes  the  exact  present  state  of  medical  knowledge  on  the  subjects  pre- 
sented; and  does  this  so  clearly,  so  concisely,  so  truthfully,  and  so  completely,  that 
his  book  on  the  uterus  will  always  mçet  the  approval  of  the  profession,  and  be  every- 
where regarded  as  a  popular  standard  work.  —  Buffalo  Medical  and  Surgical  Journal, 
August,  1871. 

Black  on  the  Functional  Diseases  of  the  Renal, 

Urinary,  and  Reproductive  Organs,  icUh  a  General  View  of  Urinary 
Pathology.  By  D.  Campbell  Black,  M.D.,  L.R.C.S.  Edinburgh, 
Member  of  the  General  Council  of  the  University  of  Glasgow,  &c.,  &c. 
Octavo.     Price, $2.50 

Bloxara's  Chemistry,  Inorganic  and  Organic. 

With  Experiments  and  a  Comparison  of  Equivalent  and  Molecular  For- 
mulae. With  2Î6  Engravings  on  Wood.  By  C.  L.  Bloxam,  Profes- 
sor of  Chemistry  in  King^s  College,  London.  Second  Edition,  care- 
fully revised.    Octavo.  .....  •  $6.50 

Bloxam's  Laboratory  Teaching  ; 

Or,  Progressive  Exercises  in  Practical  Chemistry.  With  Analytical 
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Brunton's  Experimental  Investigation  of  the 
Action  of  Medicines. 

A  Eand-book_  of  Practical  Pharmacology.  By  T.  Lauder  Brunton, 
M.D.,  D.Sc,  Lecturer  on  Materia  Medica  at  the  Middlesex  Hospital. 
12ino.     With  Wood-cuts.     In  preparation. 

Beeton's  Book  of  Household  Management. 

With  Sanitary,  Medical,  and  Legal  Memorandums  ;  also,  a  History  of 
the  Properties  and  Uses  of  all  Things  connected  with  Home  Life  and 
Conforts.  72  Colored  'and  600  other  Illustrations.  1100  pages. 
Beiny-octavo.         .......••         63.25 

Branston's  Hand-Book  of  Practical  Receipts. 

For  the  Chemist,  Druggist,  and  Medical  Practitioner,  comprising  the 
Officinal  Medicines,  their  Uses,  and  Modes  of  Preparation,  and  For- 
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Chemical  Terms. §1.50 


LINDSAY    AND    BLAKISTON's   PUBLICATIONS. 


Beasley's  3000  Prescriptions. 

FOURTH  REVISED  AND  ENLARGED  EDITION. 

Containing  3000  Preacriptions,  collected  from  the  Practice  of  the  most 
Eminent  Phi/sicians  and  Surgeons  —  English,  Frencli,  and  American; 
comprising  also  a  Compendious  History  of  the  Materia  Medica,  Listf>  of 
the  Doses  of  all  Officinal  and  Established  Preparations,  and  an  Index 
of  Diseases  and  their  Remedies.  By  Henry  Beasley,  Fourth  Edi- 
tion, Revised  and  Enlarged.     Price,     .....         $2.50 

This  edition  of  Dr.  Beasley's  Book  has  been  carefully  revised  by  the  Author,  and 
many  additions  made  to  it.  The  Publishers  by  printing  it  more  compactly  are  enabled 
to  present  it  in  a  more  convenient  form,  and  sell  it  at  a  much  reduced  price. 

"  ïhe  editor,  carefully  selecting  from  the  mass  of  materials  at  his  disposal,  has  compiled  a  volume,  in  whirh 
l)Oth  physician  and  druggist,  prescriber  and  compounder,  may  fiud,  under  the  head  of  cAch  remedy,  the  mon- 
ner  in  which  that  remedy  may  be  most  elîectivoly  administered,  or  combined  with  other  medicines  in  the 
treatment  of  various  diseases.  The  alphabetical  arrangement  adopted  renders  this  easy;  and  the  value  of  the 
volume  is  still  further  enhanced  by  the  ehort  account  given  of  each  medicine,  and  the  lists  of  doses  of  iti 
lèverai  preparations." — Lancet. 

Beasley's  Druggists'  General  Receipt  Book. 

SEVENTH  AMERICAN  EDITION,  REVISED  AND  IMPROVED. 

Comprising  a  copious  Veterinary  Formulary,  numerous  Receipts  of  Patcîit 
and  Proprietary  Medicines,  Druggists'  Nostrums,  etc.;  Perfumery  and 
Cosmetics,  Beverages,  Dietetic  Articles  and  Condiments,  Trade  Chemicals, 
Scientific  Processes,  and  an  Appendix  of  Useful  Tables,  by  Henry 
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from  the  Last  London  Edition.     Octavo S3. 50 

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und  we  can  recommend  it  as  one  of  the  best  of  the  kind."  —  A  m^ri<:an  Druggists'  Ciradar. 

Beasley's  Pocket  Formulary. 

THE    NINTH    LONDON    EDITION. 

A  Synopsis  of  the  British  and  Foreign  Pharmacopœias,  comprising 
Standard  and  Approved  Formulée  for  the  Preparations  and  Com- 
pounds emploj/ed  in  Medical  Practice.  Ninth  Edition,  Revised  and 
Enlarged.     Price, •         $2.50 

Earth  &  Roger's  Manual  of  Auscultation  and 

Percussion,     a  new  American   Translation,  from  the   Sixth 
French  Edition.     16mo $1.25 

Boucliardat's  Annual  Abstract 

Op  Therapeutics,  Materia  Medica,  Pharmacy,  and  Toxicology,  for 
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WORKS  BY  DR.   LIONEL  S.  BEALE,  F.R.S., 

Fellow  of  the  Koynl  College  of  Physicians,  Physician  to  King's  College  Hospital. 

Seventh  Thousand.     Four  Hundred  Illustrations,  some  Colored. 
SOW  TO  WORK  WITH  THE  MICROSCOPE. 

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Octavo.      Cloth.      Price,  $7.50. 

0¥   KIDNEY 'DISEASES,   URINARY    DEPOSITS,    AND    CALCULOUS 
DISORDERS:—  The  Third  lùlithm. 
Including  the  Symptoms.  Diagnosis,  and  Treatment  of  Urinary  Diseases.     With  full 
Directions  for  the  Chemical  and  Micrc^copical  Analysis  of  the  H'-ine  in  Health  and 
Disease.     70  Plates,  415  figures,  copied  from  Nature.     Octavo       Price,  $10.00. 

THE  USE  OF  THE  MICROSCOPE  IN  PRACTICAL  MEDICINE. 

For  Students  and  Practitioners,  with  full  directions  for  examining  the  various  secrc 
tions,  &c..  iu  the  Microscope.    4th  Edition.   500  Illustrations.    Octavo.    Price, 

BIOPLASM. 

A  New  Introduction  to  the  Studj^  of  Physiology  and  Medicine,  for  Students.  With 
Plates.     Price,  $3.00. 

LIFE,  MATTER,  AND  MIND  ;  OR  PROTOPLASM. 

With  Original  Observations  on  ^Minute  Structure,  and  numerous  New  Colored 
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DISEASE  GERMS:  AND  ON  THE  TREATMENT  OF  DISEASES  CAUSED 
BY  THEM.  Second  Edition,  much  enlarged,  vnth  28  plates,  [many  of  them 
colored.) 

Part      I.  —  Supposed  Nature  of  Disease  Gebms. 
Part    II.  —  Real  Nature  of  Disease  Germs. 
Part  III.  —  The  Destruction  of  Disease  Germs. 

Demy-octavo.     Price,  $5.00 

PHYSICAL  THEORIES    OF  LIFE:   THEIR   INFLUENCE  UPON  RE- 
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With  Observations  on  the  Hypotheses  recently  advocated  by  Tyndall  and  Huxley. 

ON  DISEASES  OF  THE  LIVER,  AND  THEIR  TREATMENT. 

A  Second  Edition,  much  enlarged,  of  the  Author's  Work  on  the  Anatomy  of  the 
Liver.     Numerous  Plates.     Preparing. 

THE  ARCHIVES  OF  MEDICINE.    Part  XVII.    noio  ready.    Price,  $1.50. 

CoNiENTS. — Medicine  uiiler  the  Romans — Action  of  Eyelids  in  Expiration;  F. 
C.  Donders,  Utrecht — Lacunae  and  Canaliculi — Nerves  in  Mesenteric  Glands  ;  Dr. 
Popper,  St.  Petersburg — German  Criticism  and  British  Medical  Science — Homology 
of  Coracoacromial  Ligament;  J.  B.  Perrin — Sulpho-carbolates,  by  Dr.  Sansom — 
Structure  of  the  Liver;  Editor — Sputum  in  Phthisis. 

DISEASE  :  ITS  NATURE  AND  TREATMENT.    Preparing. 

New  Researches  on  Intiammation  arid  Fever,  and  on  the  Nature  of  Contagion. 
With  Observations  on  the  Cattle  Plague  and  on  Cholera.  Numerous  Colored 
Plates.  Being  the  Third  Course  of  Lectures  delivered  at  Oxford  by  direction  of  the 
RadclifFe  Trustees. 

All  these  iVorks  contain  the  renults  of  the  Author's  original  investigations.  They  are  lUustrated 
rilh  upwards  of  2000  Engravings,  copied  from  the  actual  objects,  all  of  which  have  been  dratcM 
>n  ici't  d  by  the  Author  himself,  or  under  his  immediate  superintendence. 


LINDSAY   AND   BLAKISTON's   PUBLICATIONS. 

Biddle's  Materia  Medica.    fifth  edition. 

For  the  Use  of  Students.     With  Illustrations.     Bj  J.  B.  Biddle,  M.D 
Professor  of  Materia  Medica  and  Therapeutics  in  the  Jefferaon  Med- 
ical College,  Philadelphia,  &c.,  &c.     Revised  and  Enlarged.        $4.00 
This  is  a  thoroughly  revised  aud  enlarged  edition  of  Prof.  Biddle's  work  on  Materia 
Medica.     It  is  designed  to  present  the  leading  facts  and  principles  usually  compi-ised 
under  this  head  as  set  forth  by  the  standard  authorities,  and  to  fill  a  vacuum  which 
seems  to  exist  in  the  want  of  an  elementary  work  on  the  subject.     The  larger  works 
usually  recommended  as  text-books   in   our  Medical  schools  are  too  voluminous  for 
convenient  use.     This  will  be  found  to  contain,  in  a  condensed  form,  all  that  is  most 
valuable,  and  will  supply  students  with  a  reliable  guide  to  the  courses  of  lectures  on 
Materia  Medica  as  delivered  at  the  various  Medical  schools  in  the  United  States. 

Aids  to  the  Diagnosis  of  Diseases  of  the  Kid- 

NEYS.    By  W.  R.  Basham,  M.D.,  F.R.C.P.,  Senior  Physician  to  the 
Westminster  Hospital.     With  Tea  Plates.    Octavo.     Price,         $J.OO 

Birch  on  Constipated  Bowels. 

The  Various  Causes  and  the  Different  Means  of  Cure.  By  S.  B.  Birch, 
M.D.,  Member  of  the  Royal  College  of  Physicians  of  London,  &c. 
Third  Edition.     Price, $1.00 

Braithwaite's  Epitome  of  the  Retrospect  of 
Practical  Medicine  and  Surgery.  2  vois.  $10.00 

Chambers  on  the  Renewal  of  Life. 

Lectures  chiefly  Clinical,  illustrative  of  a  Restorative  System  of  Medi- 
cine. By  Thos.  K.  Chambers,  M.D.,  Physician  to  St.  3Iary's  Hos- 
pital, author  of  "The  Indigestions,"  &c.,  &c.  A  new  American  from 
the  Fourth  London  Edition.     Octavo,  .         .         .  $5.00 

"  This  work  is  of  the  highest  merit,  written  in  a  clear,  masterly  style,  and  devoid 
of  technicalities.  It  is  simply  what  it  professes  to  be.  Lectures  Clinical,  delivered 
from  cases  observed  at  the  bedside;  therefore  more  valuable  as  enunciating  the  views 
and  experiences  of  a  practical  mind  aided  by  actual  observation.  They  are  of  deep 
interest,  and  replete  with  facts  having  a  practical  bearing,  and  will  well  repay 
perusal." — Canada  Medical  Journal. 

Chew  on  Medical  Education. 

A  Course  of  Lectures  on  the  Proper  Method  of  Studying  Medicine.. 
By  Samuel  Chew,  M.D.,  Professor  of  the  Practice  and  Principles 
of  Medicine  and  of  Clinical  Medicine  in  the  University  of  Maryland. 

$1.00 
"Dr.  Chew  was  an  eminent  member  of  the  medical  profession,  and  a  well-known 
ieacher  cf  medicine.  He  was,  therefore,  well  fitted  for  the  judicious  performance  of 
this  task,  upon  which  he  seems  to  have  entered  with  interest  and  pleasure.  It  is  a 
well-timed  book,  and  will  serve  as  a  most  excellent  manual  for  the  student,  as  well  as 
a  refreshing  and  suggestive  one  to  the  practitioner."  —  Lan<'et  and  Observer. 


LINDSAY    AND    BLAKISTON'S    PUBLICATIONS. 


Cooley's  Cyclopssdia  of  Practical  Receipts. 

THE  FIFTH  REVISED  AND  ENLARGED  EDITION. 

Containing  Processes,  and  Collateral  Information  in  the  Arti<,  Manu 
factures,  Professions,  and  Trades,  including  3Jedicine,  Pharmary,  and 
Domestic  Economjj  ;  designed  as  a  Compréhensible  Summar;/  to  the 
Pharmacopoeias  and  a  General  Book  of  Reference  for  the  Manufac- 
turer, Tradesman,  Amateur,  and  Heads  of  Families.  By  A.  J. 
CooLEY.  Revised  and  partly  Reirritlen  by  Richard  V.  TusON,  F.C.S., 
(èc.  Fifth  and  greatly  Enlarged  Edition.  Ocer  1000  lioyal-jctavo 
pages,  double  columns.     With  Illustrations.     Price,  .         .         $12.0(1 

Cobbold  on  Worms.  Lectures  on  Practical  Helminth ology, 
delivered  at  the  Medical  College  of  the  Middlesex  Hospital  ;  witJi  Cases 
illustrating  the  Symptoms,  Diagnosis,  and  Treatment  of  Internal 
Parasitic  Diseases.     By  T.  Spencer  Cobbold,  M.D.        Price,  $2.00 

AVith  the  exception  of  hydatid  formations,  the  author  has  in  these  l««ctures  more  or 
less  fully  considered  all  those  forms  of  internal  parasitism  which  ordinarily  conie  under 
the  notice  of  the  physician. 

Coles  on  Deformities  of  the  Mouthy 

Congenital  and  Acquired,  luilh  their  3Iechanical  Treatment.  By  James 
Oakley  Coles,  D.D.S.,  Member  of  the  Odontological  Society,  &c.,  (èc. 
Second  Edition,  Revised  and  Enlarged,  ivilh  S  Colored  Engravings 
and  51  Illustrations  on  Wood.       .         .         .         .         ...         $2.50 

The  second  edition  of  this  work  shows  that  the  author  has  continued  to  devote  him- 
Belf  with  zeal  to  the  investigation  and  treatment  of  a  very  interesting  class  of  cases. 
Mr.  Coles  has  especially  studied  the  congenital  cleft  palate,  and  has,  with  the  mirror, 
detected,  in  several  cases,  growtlis  in  the  naso-pliaryngeal  tonsil.  Very  beiiutiful 
colored  drawings  are  given  in  illustration  of  the  subject  of  cleft,  palate  l\Ir.  Coles 
gives  the  preference  to  mechanical  treatment,  in  both  congenital  and  pathological  per- 
forations of  the  palate,  and  his  experience  as  to  the  good  results  obtained  is  certainly 
most  encouraging.  We  recommend  the  work  to  the  study  of  both  surgeons  and  den- 
tists.—  London  Lancet. 

Coles'  Manual  of  Dental  Mechanics. 

With  an  Account  of  the  Materials  and  Apjplianccs  Used  in  Mechanical 
Dentistry,  and  numerous  Engravings  on  Wood.  By  Oakley  Coles, 
Honorarij  Dentist  to  the  Hospital  for  Diseases  of  the  Throat.  In 
preparation. 

Campbell's  Manual  of  Scientific  and  Practical 

Agriculture.      12mo.      W.ik  illustrations.  .         .         .         $1.50 

Clymer's  Epidemic  Cerebro- Spinal  Menin- 
gitis. With  an  Appendix  on  Some  Points  on  the  Causes  of  the  Disease 
as  shown  by  the  History  of  the  Present  Epidemic  in  the  City  of  New 
York.  By  Meredith  Ci-ymer,  M.D.  (Univ.  Penn.),  Fellow  of  the 
College  of  Physicians  of  Philadelphia,  Professor  of  the  Diseases  of 
the  Nervous  S//stem,  &c.,  &c.  With  a  3Iap  of  the  City  of  New  Tort, 
showing  the  Localities,  printed  in  Colors,  of  Cerebro- Spinal  Mfiuillgitis 
in  the  Epidemic  of  1872,  made  under  the  Direction  of  Moreau  Morris, 
M.D.,  City  Sanitary  Inspector  of  the  Health  Department.  Price.    $1.00 


Cazeaux's  Great  Work  on  Obstetrics. 

THE  MOST  COMPLETE  TEXT-BOOK  NOW  PUBLISHED. 
GREATLY    ENLARGED    AND    IMPROVED. 

CWNTAINING   175    ILLUSTRATIONS. 

A  Theoretical  and  Practical  Treatise  on  Midwifery,  including  the  Diseaft» 
of  Pregnancy  and  Parluriticn,  by  P.  Cazeaux,  Member  of  lite  Imjieitni 
Academy  of  Medicine  ;  Adjunct  Frof essor  in  the  Faculty  of  Medicine  of 
Paris,  etc.,  etc.  Bevised  and  Annotated  by  S.  Tarnier,  Adjunct  P-ro^ 
fessor  in  the  Faculty  of  Medicine  of  Paris  ;  Former  Climcal  Chi^^f  of  the 
Lying-in-IIospital,etc.,etc.  Fifth  American  from  the  Seventh  French  Edi- 
tion. Translated  by  \Vm.  R.  Bullock,  M.  D.  In  one  volume  Royal  Oc- 
tavo, of  over  1100  pages,  with  numerous  Lithographic  and  other  Illustra- 
tions on  Wood. 

Price,  bound  in  Cloth,  bevelled  boards,                       .         .         .         $6.50 
"  "         Leather,  ,  7.5Ô 

M.  Cazeaux's  Great  AV'ork  on  Obstetrics  has  become  classical  in  its  character,  and 
almost  an  Encycloptedia  in  its  fulness.  Written  expressly  for  the  use  of  students  of 
medicine,  and  those  of  midwifery  especially,  its  teachings  are  plain  and  explicit,  present- 
ing a  condensed  summary  of  the  leading  principles  established  by  the  masters  of  the 
obstetric  art,  and  such  clear,  practical  directions  for  the  management  of  the  pregnant, 
partufieut,  and  puerperal  states,  as  have  been  sanctioned  by  the  most  authoritative 
practitioners,  and  contirnied  by  the  author's  own  experience.  Collecting  his  materials 
from  the  writings  of  the  entire  body  of  antecedent  writers,  carefully  testing  their  correct- 
ness and  value  by  his  own  daily  experience,  and  rejecting  all  such  as  were  falsified  by 
the  numerous  cases  brought  under  his  own  immediate  observation,  he  has  formed  out  of 
them  a  body  of  doctrine,  and  a  system  of  practical  rules,  which  he  illustrates  and  enforcen 
in  the  clearest  and  most  simple  manner  possible. 

OPINIONS  OF  THE  PRESS. 

"It  is  unquestionably  a  work  of  the  highest  excellence,  rich  in  information,  and  perhaps  fuller  in  details 
than  any  text-book  with  which  we  are  acquainted.  The  author  has  not  merely  treated  of  every  que*>- 
tion  which  relates  to  the  business  of  parturition,  but  he  has  done  so  with  judgment  and  ability." 
Briiinh  and  Foreitjn  Medico-Chirunjical  lievieio. 

"The  translation  of  Dr.  Bullock  is  remarkably  well  done.  We  can  recommend  this  work  to  those 
especially  interested  in  the  subjects  treated,  and  can  especially  recommend  the  American  edition." 
Mfiditai  Times  and  Gazette. 

"The  edition  before  us  is  one  of  unquestionable  excellence.  Every  portion  of  it  has  undergone  a. 
thorough  revision,  and  no  little  modification  ;  while  copious  and  important  additions  have  been  made  to 
neaMy  every  part  of  it.  It  is  well  and  beautifully  illustrated  by  numerous  wood  and  litbogniphir 
en^-ravings,  and,  in  typograjjhical  execution,  will  bear  a  favorable  comparison  with  other  works  cf  the 
same  class." — American  Medical  Journal. 

"In  the  multitudinous  collection  of  works  devoted  to  the  propagation  of  human  beings,  and  to  th; 
detailM  of  parturition,  none,  in  our  estimation,  bears  any  comparison  to  the  work  of  CazeauX;  iu  its 
entire  perfectness  ;  and  if  we  were  called  upon  to  rely  alone  on  one  work  on  accouchments,  our  ehciee 
WoulJ  fall  upon  the  book  before  u.s  without  any  kind  of  hesitation." — Went.  Jour,  of  Med.  a:.A  Surgery. 

"We  do  not  hesitate  to  say,  that  it  is  now  the  most  complete  and  best  treatise  on  the  subject  in  tbs 
English  language." — Buffalo  Medical  Journal. 

"We  know  of  no  work  on  this  all-iuiportant  branch  of  our  profession  that  we  can  recommend  to  the 
Bludent  or  practitioner  as  a  safe  guide  before  this." — Chicago  Medical  Journal. 

"Among  the  many  valuable  treatises  on  the  science  and  art  of  obstetrics,  the  work  of  Cazeaux  stands 
pre-eminent." — St.  Louis  Med.  and  Surg.  Journal. 

"  M.  Cazeaux's  book  is  the  most  complete  we  have  ever  seen  upon  the  subject.  It  is  well  translated,- 
mi  refieota  great  credit  upon  D~.  Bullock's  intelligence  and  industry." — N.  A.  Medico-Chirurg.  RemciM 


L.INDSAY   AND    BLAKISTON  S   PUBLICATIONS. 


Cleaveland's  Pronouncing  Medical  Lexicon. 

Containing  the    Correct  Pronunciation  and  Définition  of  most  of  the 
Terms  used  by  Speakers  and  Writers  of  Medicine  and  the  Collateral 
Sciences.     By  C.  H.   Cleaveland,  M.D.,  Member  of  the  American 
Medical  Association,  éc,  &c.     A  New  and  Improved  Edition.     81.25 
This  little  work  is  not  only  a  Lexicon  of  all  the  words  in  common  use  in  Meilicine, 
but  it  i-i  also  a  Pronouncing  Dictionary,  a  feature  of  great  value  to  Medical  Students. 
To  the  Dispenser  it  will  prove  an  excellent  aid,  and  also  to  the  Pharmaceutical  Student. 
It  contains  a  List  of  the  Abbreviations  used  in  Prescriptions,  together  with  their  mean- 
ing; and  also  of  Poisons  and  their  Antidotes.     It  has  received  strong  commendation 
both  from  the  Medical  Press  and  from  the  profession. 

Cohen  on  Inhalation. 

Ils  Therapeutics  and  Practice.  A  Treatise  on  the  Inhalation  of  Gases, 
Vapors,  Nebulized  Fluids,  and  Powders  ;  including  a  Descriptioi  of 
the  Apparatus  employed,  and  a  Record  of  Numerous  Experiments, 
Physiological  and  Pathological;  with  Cases  and  Illustrations.     By  I. 

SoLis  Cohen,  M.D.     12mo.     Price, $2.50 

■*We  recognize  in  this  book  the  work  of  a  persevering  Physician  who  has  faithfully 
studied  his  subject,  and  added  to  its  literature  much  that  is  useful  from  his  own  expe- 
rience. Dr.  Cohen  has  given  us  briefly  and  clearly  whatever  is  valuable  in  relation  to 
the  insufflation  of  powders  in  respiratory  affections,  with  the  experimental  proofs  and 
pathological  evidence  of  their  penetration  into  the  bronchial  tubes  and  lung  tissues." 
American  Journal  of  Medical  Science,  July,  1868. 

Carson's.  History  of  the  Medical  Department 

Of  the  University  of  Pennsylvania,  from  its  Foundation  in  1*765:  loitk 
Sketches  of  Deceased  Professors,  éc.  By  Joseph  Carson,  M.D., 
Professor  of  Materia  Medica  and  Pharmacy  in  the  University.  $2.00 

Chavasse  on  the  Mental  Culture  and  Training 

of  a  Child,  and  on  various  other  subjects  relating  to  Health  and  Hap- 
piness.  Addressed  to  Parents.  By  Pye  Henry  Chavasse,  F.R.C.S. 
Foolscap.     12mo.  §1.50 

Dixon  on  the  Eye. 

A  Guide  to  the  Practical  Study  of  Diseases  of  the  Eye,  with  an  Outline 
of  their  Medical  and  Operative  Treatment,  with  Test  Types  and  Illus- 
trations.    Third  Edition,  thoroughly  Revised,  and  a  great  p)ortion  Re- 
written.    By  James  Dixon,  F.R.C.S.,  Sui^geon  to  the  Royal  LorAicn 
Ophthalmic  Hoi<pital,  &c.,  éc.     In  one  volume.     Price,        .         §2.50 
"Mr.  Dixon's  book  is  essentially  a  practical  one,  written  by  an  observant  author, 
WÛO  brings  to  Lis  special  subject  a  sound  knowledge  of  general  Medicine  and  Sur» 
gery."  —  Dublin  Qitarterly. 


LINDSAY  AND   BLAKISTON's    PUBLICAllONS. 

Duchenne's  Localized  Electrization. 

Translated  from  the  Third  Edition,  by  Herbert  Tibbits,  M.D.,  L.R. 
C.P,,  Lond.,  Medical  Superintendent  of  the  National  Hospital  for  the 
Paralyzed  and  Epileptic.  With  92  Illustrations,  and  Notes  and  Addi- 
tions by  the  Translator.     Price,    .         .  ...         $3.00 

This  part  of  Duchenne's  great  work  is  a  translation  from  the  third  edition  now  being 
prepared  by  the  author,  and  contains  all  that  has  yet  been  printed,  and  is  published 
even  before  the  original  is  issued.  It  is  not  only  a  well-nigh  exhaustive  treatise  on 
the  medical  uses  of  Electricity,  but  it  is  also  an  elaborate  exposition  of  the  different 
diseases  in  which  Electricity  has  proved  to  be  of  value  as  a  therapeutic  and  diagnostic 
agent.     No  similar  treatise,  it  is  believed,  exists  in  the  English  language. 

Part  II.,  illustrated  by  chromo-lithographs  and  numerous  wood-cuts,  is  preparing. 

Dunglison's  History  of  Medicine, 

From  the  Earliest  J ges  to  the  Commencement  of  the  Nineteenth  Century. 
By  RoBLEY  DuNGLisoN,  M.D.,  LL.D.,  late  Professor  of  Institutes  of 
3Iedicine  and  Medical  Jurisprudence  in  the  Jefferson  Medical  Col- 
lege of  Phi(adeip/na,  éc,  éc.  Now  first  Collected  and  Arranged 
from  the  Original  Manuscript,  by  his  son,  Richard  J.  Dungltson, 
M.D.     Subscription  price, $2.50 

The  proposed  publication  of  a  posthumous  work  by  this  distinguished  author  aâd 
teacher  must  be  a  mutter  of  general  interest  to  the  profession,  to  whose  advancement 
he  devoted  so  many  years  of  iiis  valuable  life.  No  writer  of  this  century  was  so  pro- 
lific in  contributions  to  medical  science,  and  the  great  success  of  his  excellent  treatises 
in  the  various  departments  of  medicine  form  a  memorable  chapter  in  the  history  of 
American  literature.  It  forms  a  small  octavo  volume  of  280  pages,  printed  on  tinted 
paper,  handsomely  bound  in  cloth,  bevelled  boards.  It  will  be  sent  by  mail,  postage 
paid,  to  subscribers  who  remit  the  amount  in  advance. 

Dobell  00  Winter  Cough  {'^2^^^éIi:'ÏS'^S:) 

Lectures  Delivered  at  the  Royal  Hos^ntal  for  Diseases  of  the  Chest,  iij 
Horace  Dobell,  M.D.,  Senior  Physician  to  the  Hospital.  New  and 
Enlarged  Edition,  with  Colored  Plates.     Octavo.     Price,    .         $3.50 

Darlington's  Flora  Cestrica;  or,  herborizing  companion. 

Containing  all  the  Plants  of  the  Middle  States,  their  Linnsean  Arj^ange- 
ment,  a  Glossary  of  Botanical  Terms,  a  complete  Index,  &c.  By 
William  Darlington,  M  D.     TJdrd  Edition.     12mo.         .        $2.25 

Dillnberger's  Handy-Book  of  the  Treatment 
of  Women  and  Children's  Diseases,  according 

to  the  Vienna  Medical  School. 

Part  I.  The  Diseases  of  Women.  Part  II.  The  Diseases  of  Children. 

Translated  from  the    Second  German    Edition,  by  P.  NicOL,  M.D. 
One  volume  li!mo.     Price,    .......         $1.Î5 

"We  noticed  favorably  the  original  of  this  hand-book  some  months  ago,  and  sug- 
gested that  an  English  translation  of  it,  with  notes  showing  the  main  points  wherein 
tJie  practice  of  our  medical  schools  differs  from  that  at  Vienna,  might  be  well  received. 
Mr.  Nicol  has  now  carried  out  this  idea,  and  we  imagine  that  many  practitioners  will 
be  glad  to  possess  this  little  manual,  which  gives  a  large  mass  of  practical  hints 
respecting  the  treatment  of  diseases  which  probably  make  up  the  larger  half  of  every- 
day practice.  The  translation  is  well  and  correctly  performed,  and  the  necessary 
explanations  of  reference  to  German  medicinal  preparations  are  given  with  propei 
fullness."  —  The  Practitioner 


LINDSAY    AND   BLAZISTON's   PUBLICATIONS. 

Durkee  on  Gonorrhœa  and  Syphilis. 

The  Fifth  Edition,  Revised  and  Enlarged,  with  Portraits  and  Colored 

Illustrations.     By  Silas  Durkee,  M.D.,  Fellow  of  the  Massachusetts 

Medical  Society,  &c.,  &c.     A  New  and  Revised  Edition,  with  Eight 

Colored  Illustrations.     Octavo $5.00 

"Dr.  Durkee's  work  impresses  the  reader  favorably  by  the  skill  with  which  it  ii 
arranged,  the  manner  in  which  the  facts  are  cited,  the  clever  way  in  wiiich  the  aulhor't 
esfjerience  is  brought  in,  the  lucidity  of  the  reasoning,  and  the  care  with  which  the 
therapeutics  of  venereal  complaints  are  treated."  — Lancet. 

Elam  on  Cerebria  and  other  Diseases  of  the 

Jjrain.  By  Charles  Elam,  M.D.,  Fellow  of  the  Royal  College 
of  Physicians  ;  Author  of  "A  Physician^s  Problems,"  &c.,  &c.,  &c. 
Octavo.     Price, §2.50 

Fuller  on  Rheumatism,  Rheumatic  Gout,  and 

Sciatica,     third  edition,     octavo.     Price,         .         $5.00 

Flint's  Reports  on  Continued  Fever. 

*With  an  Analysis  of  164  cases,  &c.,  &c.  By  Austin  Flint,  M.D.,  &c.,  &c. 
Octavo.     Price,    .........         $2.00 

Fothergill.     The    Heart   and   its    Diseases. 

With  their  Treatment.  By  J.  Milner  Fothergill,  M.D.,  Author  of 
the  Hastings  Prize  Essay  on  Digitalis,  its  Action  and  its  Use.  With 
Illustrations.     Octavo,     Price, $5.00 

Fothergill  on  Digitalis. 

Its  Mode  of  Action  and  its  Use.  An  Inquiry  illustrating  the  Effect  of 
Remedial  Agents  over  Diseased  Conditions  of  the  Heart,  being  the 
Hastings  Prize  Essay  of  the  British  Medical  Association  for  1870. 
By  J.  Milner  Fothergill,  M.D.     Price,    .         .         .         .         $1  25 

Fox  on  the  Human  Teeth. 

Their  Natural  History,  Structure,  and   Treatment  of  the  Diseases  to 

which  they  are  Subject.      With  250  Illustrations.  .         .         $4.00 

Gant's  Science  and  Practice  of  Surgery. 

A  Complete  System,  including  the  Principles  and  Practice,  by  Freder- 
ick J.  Gant^  F.R.C.S.,  Surgeon  to  the  Royal  Free  Hospital,  London, 
&c.,  &c.     With  470  Illustrations.     Price,     ....         $7.50 

Mr.  Gant's  book,  as  a  whole,  is  methodical,  conscientious,  learned,  and  painstaking, 
[t  is  thoroughly  English  in  tone,  and  somewhat  hyperconscrvative  and  deferential  to 
authority.  It  is  an  excellent  compilation  of  received  opinions,  and  a  correct  guide  to 
established  modes  of  practice.  It  is  a  better  volume  for  a  surgeon  than  for  a  student's 
text-book.  It  is  a  good  guide  to  the  study  of  surgery,  and  abounds  in  valuable  facts 
and  statistics.  The  style  is  generally  clear  and  elegant.  We  advise  surgeons  who  can 
afford  it  to  buy  the  book.  —  New  York  Medical  Journal,  Feb.,  1872. 

Gant's  Irritable  Bladder. 

Its  Causes  and  Curative  Treatment.  Third  Edition,  Revised  and  Eu' 
larged.     With  New  Illustrations.     8vo.      Price,  .         ,         S2.50. 


l:ni;say  and  blakiston's  publications. 

Gioss'  American  Medical  Biography  of  the 
Nineteenth  Century. 

Edited  by  Samuel  D.  GR0fe3,  M.D.,  Professor  of  Surgery  in  the  Jrfers>jn 
Medical  College,  Philadelphia,  &c.,  &c.  With  a  Portrait  of  Benjamin 
Rush,  ISI.D.     Octavo S3.50 

GreenhoW  on  BrOncbitis^  especially  as  connected  with 
Gout,  Emphysema,  and  Diseases  of  the  Eeart.  By  E.  Headlam  Green 
HOW,  M.D.,  Fellow  of  the  Royal  College  of  Physicians,  £c.,  £c. 

Price,  $2.00 

"In  vivid  pictures  of  the  sort  of  cases  wliicli  a  pi-actitioner  encounters  i:»  his  daily  walks,  and  in  examples 
of  the  way  iu  wliicli  a  student  ought  to  turn  them  over  in  his  mind  ùnd  make  them  tools  for  Beif-improve- 
ment,  we  have  rarely  seen  a  volume  richer."  —  £rit.  and  For.  Medico-CHirura.  .Çet-i<«»-. 

Garratt's  (Alfred  C.)  Guide  for  "Dosing  Medical 
Batteries. 

Shoiving  the  most  approved  Âpj)aratus,  Methods,  and  Rules  for  the  Medical 

•        Employment  of  Electricity  in  the  Treatment  of  Nervotis  Diseases,  &c.,  &e. 

With  numerous  Illustrations.     One  Volume,  octavo,       .         .         62.00 

"The  large  work  on  the  same  subject,  and  by  tVie  same  author,  is  pretty  well  known  to  the  Profession,  buî 
It  is  bulky  and  cumbrous,  and  by  no  means  so  practically  useful.  The  present  comparatively  brii'f  volume 
contains  every  thing  of  importance  in  regard  to  the  various  apparatuses  useful  to  the  Medical  Electrician 
tnd  the  various  modes  of  application  foi  therapeutic  purposes."  —  Lancet  and  Observer. 

Godfrey's  Diseases  of  Hair. 

A  Popular  Treatise  upon  the  Affections  of  the  Hair  System,  with  Advice 
upon  the  Preservation  and  Management  of  Hair.  By  Benjamin 
Godfrey,  M.D.,  F.R.A.S.     Price,         ..'...         $1.50 

Chapter  1.  Introduction.  2.  Anatomy  and  Physiology  of  Hair.  3.  Excess  of  Hair.  4.  Baldness.  5.  Tri- 
chionosis  Cana.  6.  Albinism.  7.  Hair  in  the  wrong  place.  8.  Vegetable  Parasitic  Diseases.  9.  Morbui 
Paxtonii.  10.  Chignon  Fungus.  11.  Plica  Polonica.  12.  Diseases  of  Color  of  the  Hair.  13.  Pityriasis.  14. 
Phtheiriasis.  15.  Diseases  of  Hair  Follicles.  16.  Trichiasis  Ciliorum.  17.  Color  of  Ilair  in  relation  to  Char- 
acter and  Disease.    18.  Cleanliness.    I'J.  Hair  Dyes.    20.  The  Beard. 

Gardner  on  Sterility.     Its  Causes  and  Cura- 
tive Treatment.     WUh  illustrations.    Octavo.      .        $3.00 

Holden's   Manual  of  the  Dissection  of  the 

Human     Body.    WUh  Notes  and  Additions.    Plustrated.    65.00 

Hillier's  Clinical  Treatise  on  the  Diseases  of 

ChlKiren.     By  Thomas  Hillier,  M.D.,  Physician  to  the  Hospitoi 
fcr  Sick  Children,  and  to  University  College  Hospital,  &c.,  êc.     Octavo. 

Price,  S3.00 

«Our  apace  is  exhausted,  but  ■we  have  said  enough  to  indicate  and  illustrate  the  excellence  of  Dr.  Hillier'i 
Toltime.  It  is  eminently  the  kind  of  book  needed  by  all  medical  men  who  w  «h  to  cultivate  cliuital  acr-ir«cj 
tkvi  sound  practice."  —  Ltmdon  Lancet. 


LINDSAY   AND   BLAKISTON  S   PUBLICATIONS. 


Harris'  Principles  and  Practice  of  Dentistry. 

The  Tenth  Revised  Edition.  In  great  part  Re-written,  Re-arranged, 
and  with  many  New  and  Important  Illustrations.     Including 

1.  DENTAL  ANATOMY  AND  PHYSIOLOGY.  3.  DENTAL  SURGERY. 

2.  DENTAL  PATHOLOGY  AND  THERAPEUTICS.        4.  DENTAL  MECHANICS. 

By  Chapin  a.  Harris,  M.D.,D.D.S.,  &c.  The  Tenth  Edition,  Revised 
and  Edited,  by  P.  H.  Austen,  M.D.,  Professor  of  Dental  Science  and 
3Iecha.nisni  in  the  Baltimore  College  of  Dental  Surgery,  with  nearly 
400  Illustrations,  includiyig  many  new  ones  made  especially  for  (his 
edition.  Royal  Octavo,  in  Cloth,  .....  86.50 
"  "  Leather, 7.50 

This  new  edition  of  Dr.  Harris's  work  has  been  thorouglily  revised  in  all  its  parts  —  more  so  than  any  pre- 
vious edition.  So  great  have  been  the  advances  in  many  branches  of  Dentistry,  that  it  was  found  necessary 
to  rewrite  the  articles  or  subjects,  and  tliis  has  been  done  in  the  most  efficient  manner  by  Prof  Austen,  for 
many  years  an  associate  and  friend  of  Dr.  Harris,  assisted  by  Prof  Gorgas  and  Thus.  S.  Latimer,  M.D.  The 
publishers  feel  assured  that  it  will  now  be  found  the  most  complete  text-book  for  the  student  and  guide  for 
the  practitioner  in  the  English  language. 

Harris'  Dictionary,   the  third  revised  edition. 

A  Dictionary  of  Medical  Terminom)gy,  Dental  Surgery,  and  the 
Collateral  Sciences.  The  Third  Edition,  carefully  Revised  and 
Enlarged,  by  Ferdinand  J.  S.  Gorgas,  M.D.,  D.D.S.,  Professor  of 
Dental  Surgery  in  the  Baltimore  College,  &c.,  &c.  • 

Royal  Octavo,  in  Cloth, $6.50 

"  "  Leather, 7.50 

Prof.  Gorgas  is  Dr.  Harris's  successor  in  the  Baltimore  Dental  College,  and  he  has  in  a  most  satisfactory 
manner  revised  this  edition  of  bis  work,  having  added  nearly  three  thousand  new  words,  besides  making 
many  additions  and  corrections.  The  doses  of  the  more  prominent  medicinal  agents  have  also  been  added, 
and  in  every  way  the  book  has  been  greatly  improved,  and  its  value  enhanced  as  a  work  of  reference. 

Handy's  Text-book  of  Anatomy, 

And  Guide  to  Dissections.  For  the  Use  of  Students  of  Medicine  and 
Dental  Surgery.      With  312  Illustrations.     Octavo.     .         .         $4.00 

Hardwick's  Manual  of  Photographic  Chemis- 
try. With  Engravings.  Eighth  Edition.  Edited  and  Re-arranged  hy 
G.  Dawson,  Lecturer  in  Photography,  &c.,  &c.    12mo.    In  preparation. 

Harley's  Urine  and  its  Derangements, 

With  the  Application  of  Physiological  Ghemistrt/  to  the  Diagnosis  and 
Treatment  of  Constitutional  as  well  as  Local  Disease.     By  George 
Harley,  M.D.,  F.R.S.,  late  Professor  in  the  University  College,  Lon- 
don, &c.,  &c.      With  Illustrations.     One  volume.     Price,      ,         $2.75 
CosTENT.s. — Chapterl.  What  is  Urine?     2.  Changes  in  the  Composition  of  the  Urine, 
induced  by  Food,  Drink,  Medicine,  and  Disease.     3.  Urea,  Ammonajmia,  Urœmia.     4. 
Uric  Acid.     5.  Hippuric  Acid,  Chloride  of  Sodium.     6.  Urohaematin,  Abnormal  Pig- 
ments in  Urine.     7.  Phosphoric  Acid,  Phosphatic  Gravel  and  Calculi.     8.  Oxalic  Acid, 
Jxaluria,  Mulberry  Calculi.     9.  Inosite  in  Urine,  Creatin  and  Creatinine,  Cholesterin, 
Cystin,  Xanthin,  Leucin,  Tyrosin.     10.  Diabetes  Melitus.     11.  Albuminuria. 

The  subject-matter  of  this  volume  was  delivered  in  a  conrse  of  lectures  before  the  c!.i.ss  at  the  University 
College,  London,  and  puldished  in  detached  irortinns  in  the  London  Medical  Times  and  Gazelle,  where  they 
were  so  favorably  received  that  the  author  has  been  induceil  to  revise  and  enlarfre  them,  presenting  them  in 
a  far  more  accessible  form  to  the  Profession.  Professor  Harley's  book  now  offers  facilities  for  the  study  of 
Physiological  and  Pathological  Chemistry,  as  applied  to  a  class  of  diseases  that  is  otherwise  very  imjerf«cUj 
arovided  for. 


LINDSAY    AND    BLAKISTON'S    PUBLICATIONS. 

Hewitt  on  Woman,     a  new,  enlaeged,  and  im- 
proved EDITION.    WITH  NEW  ILLUSTRATIONS. 

The  Diagnosis,  Pathology,  ant»  Treatment  op  Diseases  of  Women, 
including  the  Diagnosis  of  Pregnancy.  Founded  on  a  Course  oj 
Lectures  delivered  at  St.  Mary's  Hospital  Medical  School.  By  G  rail  y 
Hewitt,  M.D.  Lend.,  M.  R.  C.  P.,  Physician  to  the  British  Li/ing-in 
Hospital  ;  Lecturer  on  Midwifery  and  Diseases  of  Women  and  Chil- 
dren  at  St.  Mary''s  Hospital  Medical  School  ;  Honorary  Secretary  to 
the  Obstetrical  Society  of  London,  éc.  The  Third  Edition,  Revised 
and  Enlarged,  with  new  Illustrations.    Octavo.    Price  in  Cloth,    $5.00 

"     "  Leather,  6.00 

"Dr.  Graily  Hewitt  has  always  been  remarkable  as  one  of  the  most  careful,  well- 
read,  thoughtful,  and  conscientious  Physicians  in  his  department  of  practice.  These 
quali'ies  give  great  literary  value  to  his  treatises;  they  are  completed  by  the  careful 
and  intelligent  application  which  he  has  made  of  his  clinical  study  of  a  large  body  of 
cases,  and  it  would  be  difiBcult  to  name  any  work  equally  satisfactory  in  its  completeness 
of  research,  judicious  discrimination  of  the  grounds  of  diagnosis,  and  practical  illua- 
tration  of  all  that  can  throw  light  upon  the  treatment  of  the  diseases  of  women  and  the 
diagnosis  of  pregnancy,  both  under  ordinary  and  extraordinary  cases.  It  is  one  of 
the  books  which  do  credit  to  our  literature." —  Brilish  Medical  Journal. 

"We  know  of  no  work  on  the  Diseases  of  Women  which  we  can  with  greater  con«- 
dence  recommend.     The  various  subjects  are  treated  with  a  fulness  and  completeness  ■ 
which  they  have  not  heretofore  received  in  this  country,  and  which  reminds  us  of  the 
exhaustive  methods  followed  in  some  of  the  best  works  of  French  and  German  medical- 
wriiers."  —  Lancet. 

'To  younger  practitioners  the  book  will  be  found  to  present  a  great  charm  in  the 
calm,  thorough,  and  impartial  examinations  it  enters  into,  of  the  various  questions  that 
are  still  sub j'udice  as  to  the  pathology  and  treatment  of  some  of  the  diseases  to  which, 
women  are  subject."  —  Dublin  Quarterly  Journal. 

"We  would  heartily  commend  Dr.  Hewitt's  work  as  a  sound  guide,  not  only  in. 
diagnosis,  but  also  in  treatment."  —  Ranking  and  Radcliffe's  Half-Yearly  Abstract. 

"  It  is  especially  a  safe  and  valuable  guide  to  the  practitioner."  —  British  and  Foreign 
Medico-  Chirurgical  Review. 

"  Readers  of  the  former  editions  will  not  require  to  be  told  that  the  additions  now 
made  are  of  the  highest  possible  excellence."  —  Times  and  Gazette. 

"  It  is  one  of  the  most  useful,  practical,  and  comprehensive  works  upon  the  subject 
in  the  English  language,  a  true  guide  to  the  student,  and  an  invaluable  means  of 
reference  for  the  teacher."  — N.  Y.  Medical  Record. 

"  The  second  edition  of  the  excellent  work  of  Dr.  Hewitt  presents  in  a  form  well 
adapted  to  conduct  the  student  to  a  knowledge  of  the  Diseases  of  Women,  and  to  assist 
the  young  practitiou'-r  in  his  study  of  tliese  diseases  at  the  bedside  of  the  patient — a 
very  full  and  clear  exposition  of  the  views  entertained  by  the  most  authoritative  teachers 
as  to  their  patliological  treatment  and  their  correct  Diagnosis.  This  commendation 
applies  especially  to  the  present  edition.  Although  the  first  edition  was  a  particularly 
excellent  e.Kponent  of  the  subject,  the  second,  besides  being  brought  down  to  a  later- 
date,  presents  a  fuller  and  more  systematically  arranged  account  of  the  Pathology  of 
the  diseases  of  the  female  in  connection  with  their  treatment."  —  Amer.  Med.  Journal. 

Haberslioii  on  the  Diseases  of  the  Liver. 

Their  Pathology  and  Treatment.  Being  the  Lettsonian  Lectures,  deliv- 
ered at  the  Medical  Society  of  London,  1 872,  by  S.  0.  IIabershon,  M.D., 
Physician  to  G uy^ s  Hospital,  éc.     Price,      ....         SI. 50 


LINDSAY   AND    BLAKISTON'S   PUBLICATIONS. 


Headland  on  the  Action  of  Medicines  in  the 

System.      sixth  American  edition. 

By  F.  "W.  Headland,  M.D.,  Fellow  of  the  Eoyal  College  oj  Physiciam^ 
&c.,  &G.  Sixth  American  from  the  Fourth  London  Fdiiion.  lievi-t<ed 
and  enlarged.     One  Volume,  octavo So.^O 

Dr.  Headland's  work  has  bceu  out  of  print  in  this  country  nearly  two  years,  awp't- 
ing  the  revivions  of  the  author,  which  now  appear  in  this  edition.  It  gives  the  Oi)l3 
Bcientific  and  satisfactory  view  of  the  action  of  medicine;  and  this  not  in  the  way  of 
idle  speculation,  but  by  demonstration  and  experiments,  and  inferences  almost  as  in- 
disputable as  demonstrations.  It  is  truly  a  great  scientific  work  in  a  small  compass, 
and  deserves  to  be  the  handbook  of  every  lover  of  the  Profession.  It  has  received  the 
most  unqualified  approbation  of  the  Medical  Prf^s,  both  in  this  country  and  in  Europe, 
and  is  pronounced  by  them  io  be  the  most  oriyinal  and  practically  useful  work  that  has 
been  published  for  many  years. 

Hille's  Pocket  An.^iomist. 

Being  a  Complete  Description  of  the  Anatomy  of  the  Suman  Body  ;  for  the 
Use  of  Students.  By  M.  "W.  Hilles,  formerly  Lecturer  on  Anatomy  and 
Physiology  at  the  Westminster  Hospital  School  of  Medicine. 

Price,  in  cloth, $1.00 

"      ifl  Pocket-book  form, 1.26 

Heath  on  the  Injuries  and  Diseases  of  the  Jaws. 

The  Jacksonian  Prize  Essay  of  the  Eoyal  College  of  Surgeons  of  Eng 
land,  1867.  By  Christopher  Heath,  F.R.  C.S.,  Assistant  Surgeon  ti 
University  College  Hosjiital,  and  Teacher  of  Operatii^e  Surgery  in  Uni- 
ver sity  College.    Containing  over  \bO  Illustrations.  Octavo.    Price,  S'>. Of 

Hodge  on  Foeticide,  or   Criminal  Abortion. 

By  Hugh  L.  Hodge,  M.  D.,  Emeritus  Professor  in  the  Uni'jcrsity  of 
Pennsylvania.     Fourth  Edition.  Price  in  paper  covers,      30 

flexible  clo^h,     50 

This  little  hook  is  intended  to  place  in  tlie  hands  oi  professional  men  and  others  thp  mépris  of  «cowering 
ïatisfactorily  and  intelligently  any  iucjuiiiea  that  may  be  made  of  them  in  conueotioii  .<i,h  this  important 
niliject. 

Holmes'  Surgical  Diseases  of  Ii7fancy  and 

C  hlldhood.  By  J.  PIoLMES,  M.A.,  S'Uigejn  to  the  Hospital  fa-- 
Si?k  Children,  (èc.     Second  Edition.     Revised  and  Enlarged.     Octavo. 

Price,  $7.50 

Hufeland's  Art  of  Prolonging  Life.     Eduedbv 

Erasmus  Wilson,  M.D.,  F  R.S.  Author  of  "A  System  of  IJuman 
Anort-omy,'^  "  Diseases  of  the  Skin.^-  &c.,  &c.     12mo.     Cloth.  $1.25 


LINDSAY   AND    BLAKISTON's    PUBLICATIONS. 


Hewsoii's  Earth  in  Surgery. 

EAKTH  AS  A  TOPICAL  APPLICATION  IN  SURGEET. 

Being  a  full  Exposition  of  its  use  in  all  the  Cases  requiring  Toj/ical  Appli- 
cations admitted  in  the  Men's  and  Women's  Surgical  Wardb  of  the  Fenrir 
sylvania  Hospital  daring  a  period  of  Six  Months  in  1869.  With  Four 
full-page  Photo-Relief  Illuslraiioyis.  By  Addinell  Hewson,  M.D.,  one 
of  the  Attending  Surgeons  to  the  Pennsylvania  Hospital. 
"What  I'elates  to  Truth  is  greater  than  what  relates  to  Opinion."  —  Bacon. 

CONTENTS. 

Preface;  Introduction;  Histories  of  Cases;  Comments  as  to  the  Effects  of  the  Contact 
of  the  Earth;  Its  Effects  on  Pain;  Its  Power  as  a  Deodorizer;  Its  Influence  over  Inflam- 
mation ;  Its  Influence  over  Putrefaction  ;  Its  Influence  over  the  Healing  Processes  ; 
Modus  Operandi  of  the  Earth;  As  a  Deodorizer  and  over  Putrefaction;  In  its  Effects  on 
Living  Parts. 

In  One  Volume.     Price,  $2.50. 

This  volume  presents  the  results  of  researches  by  the  author  into  the 
actions  of  Earth  as  a  surgical  dressing,  and  embraces  the  histories  of  over 
ninety  cases  which  occurred  in  the  wards  of  the  Pennsylvania  Hospital  some 
three  years  since,  but  whose  publication  has  been  delayed  until  now,  for  the 
double  purpose  of  weighing  them  by  subsequent  expei'ience,  and  of  inter- 
preting their  meaning  by  a  careful  study  of  the  various  subjects  which  they 
involve. 

The  illustrations  are  introduced  for  the  purpose  of  giving  a  demonstration  as  strong 
as  possible  of  the  successes  attending  these  experiments,  and  are  from  photographs 
reproduced  by  a  method  that  would  seem  to  leave  nothing  to  be  desired  as  to  perma- 
nency, as  well  as  faithfulness  and  accuracy  of  representation. 

Opinion  o/S.  D.  Gross,  M.D.,  LL.D.,  Professor  of  Surgery  in  the  Jefferson  Bledical  College, 

Philadelphia. 

I  have  perused  with  great  interest  and  profit  the  work  of  Dr.  Addinell  Hewson,  en- 
titled "Earth  .is  a  Topical  Application  in  Surgery,"  and  regard  it  as  a  highly  valuable 
contribution  to  the  literature  of  the  profession,  destined  as  it  is  from  the  novelty  of  the 
subject  of  which  it  treats  to  attract  general  attention,  inquiry,  and  experiment.  The 
author  has  shown  himself  to  be  an  original  thinker,  and  the  treatment  which  he  is 
laboring  to  introduce  is  worthy,  as  I  can  testify  from  personal  observation,  of  a  fair 
and  impartial  trial. 

April  6,  1872. 

Extract  of  a  Letter  from  Jos.  Pancoast,  M.D.,  Professor  of  Anatomy  in  Jefferson  Medical 

College,  Philadelphia. 

I  am  glad  you  have  brought  the  subject  so  perfectly  to  the  notice  of  the  profession, 
as  Earth  Treatment  is  destined  hereafter  to  be  one  of  the  acknowledged  resources  of 
Surgery. 

March  2,  1872. 

The  cases  conclusively  show  that,  as  a  rule,  the  contact  of  the  earth  is  cooling  and 
pleasant  to  the  wound,  reduces  the  pain,  deodorizes,  prevents  putrefaction,  and  hastens 
the  healing  process.  These  results  are  the  highest  possible  testimonials  in  its  favor. 
No  surgeon  should  neglect  to  read  this  evidence,  the  means  being  so  simple  and  obtain- 
able.—  Medical  and  Surgical  Reporter,  March  23,  1872. 

The  subject  is  one  of  much  practical  importance,  and  the  book  will  amply  repay 
both  physician  and  surgeon  for  the  time  involved  in  its  careful  reading.  —  Ghicaga 
Medical  Examiner,  March  1,  1872. 


LINDSAY   AND   BLAKISTON^S   PUBLICATIONS. 


Kirkes'  Hand-Book  of  Physiology. 

THE    EIGHTH    LONDON    EDITION. 

HAND-BOOK  OF  PHYSIOLOGY,  by  Will: am  Senhocse  KiRKEa 
M.D.  Seventh  Edition,  edited  byW.  Morrant  Baker,  F.R.C.S.,  Lec- 
turer on  Physiology,  &c.,  &c.  With  241  Illustrations.  In  one  volume, 
demy-octavo,  containing  over  800  pages.    Price,  bound  in  cloth,  $.5.00, 

Tbia  edition  of  Br.  Kirkes'  Hand-Book  of  Physiology  is  fully  brought  up  to  the  times,  and  forms  oua  of  tho 
most  complete!  and  convenient  Text-Books  on  the  subject,  for  the  Student  of  Medicine,  now  iu  print. 

Lewin  on  Syphilis.     With  Illustrations. 

THE  TREATMENT  OF  SYPHILIS  with  Subcutaneous  Sublimate 
Injections.  With  a  Lithographic  Plate  illustrating  the  Mode  and  Proper 
Place  of  administering  the  Injections,  and  of  the  Syringe  used  for  the 
purpose.  By  Dr.  Georg  Lewin,  Prof  essor  at  the  Fr.-Wilh.  University, 
and  Surgeon-in- Chief  of  the  Syphilitic  Wards  and  Skin  Diseases  of 
the  Charity  Hosjntal,  Berlin.  Translated  by  Carl  Prœgler,  M.D., 
late  Surgeon  in  the  Prussian  Service  and  in  the  United  States  Army, 
and  E.  H.  Gale,  M.D.,  late  Surgeon  in  the  United  States  Army. 

In  One  Yolume.  small  Octavo.     Price,     .      .        .      82.25 

Legg  on  Urine,   the  third  london  edition. 

A  Guide  to  the  Examination  of  the  Urine.  For  the  Practitioner  and 
Student.  By  J.  Wickuam  Legg,  M.D.,  Member  of  the  Royal  College 
of  Physicians,  &c.,  &c.    Third  Edition.     16mo.     Cloth.    Price,  75  cts. 

"Dr.  LegK's  little  manual  has  met  with  remarkable  success,  and  the  speedy  exhaustion  of  the  first  edition 
tas  enabled  the  author  to  make  certain  emendations  which  have  added  greatly  to  its  value.  VTe  can  now 
confidently  commend  it  to  the  student  as  a  safe  and  reliable  guide  to  such  examinations  of  the  urine  as  he 
may  be  called  upon  to  make.'"  —  London  Medical  Times  and  Gazette. 

Lawson's  Diseases  and  Injuries  of  the  Eye, 
their  Medical  and  Surgical  Treatment,   wuh 

Illustrations.  By  George  Lawson,  F.R.C.S.,  Surgeon  to  the  Royal 
London  Ophthalmic  Hospital,  and  Assistant  Surgeon  to  the  Middlesex 
Hospital.     In  one  volume,  royal  12mo.     Price,     .         .         .         $2.50 

This  Manual  comprises  a  brief  account  of  all  the  Medical  and  Surgical 
Affections  of  the  Eye,  with  the  Treatment  essential  for  their  relief,  each 
subject  being  discussed  in  a  separate  section  under  its  own  peculiar  head- 
ing. The  numerous  and  very  favorable  notices  of  the  volume  attest  its 
great  value  to  the  student. 

Le    Gros    Clark's  Outlines  of  Surgery  and 

Surgical  Pathology,  including  the  Diagnosis  and  Treatment  of  Obscure 
and  Urgent  Cases,  and  the  Surgical  Anatomy  of  some  Important  Struc- 
tures and  Regions.  By  P.  Le  Gros  Clark.  F.R.S.,  Senior  Surgeon 
to  St.  Thomas's  Hospital.  Assisted  by  W.  W.  Wagstaffe,  F.R.C.S., 
Resident  Assistant-Surgeon  of,  and  Joint  Lecturer  on  Anatomy  at,  St. 
Thomas's  Hospital.    Second  Edition,  Pvevised  and  Expanded.    Octavo. 

Price,  $4.25 


Meigs  and  Pepper  on  Children.  :^ 

FOURTH  EDITION,  ENLARGED  AND  IMPROVED. 
The  publishers  have  selected  the  following  notice,  from  a  late  number  of 
the  London  Lancet,  of  the  New  Edition  of  this  work,  as  indicating,  per- 
haps, more  fully  than  any  other  of  the  numerous  favorable  criticisms  that 
have  appeared  of  it  elsewhere,  its  great  value  to  the  Pracliiioner  and 
Student  of  Medicine. 

•'It  is  not  necessary  to  say  much,  in  the  way  of  criticism,  of  a  work  so  well  known 
as  Meigs  on  Diseases  of  Children,'  especially  when  it  has  reached  a  fourth  edition. 
Our  duty  is  wellnigh  restricted  to  the  point,  of  ascertaining;  how  far,  mider  an  old 
color,  it  preserves  the  freshness  and  the  value  of  a  new  book  —  how  fai'  it  incorpo- 
rates whai,  is  new  with  what  is  old  without  unseemly  marks  of  mere  joining.  There 
is  some  advantage  in  starting  entirely  afresh,  in  being  merely  clinical,  or  in  being  very 
short,  and  limiting  one's  self  to  the  expression  of  one's  own  views  and  experience. 
But  such  is  not  the  nature  of  this  book,  and  the  advantages  of  it  are  ditierent.  It  is  a 
work  of  more  than  900  good  American  pages,  and  is  more  encyclopœdial  than  clinical. 
But  it  is  clinical,  and  withal  most  effectually  brought  up  to  the  light,  pathological  and 
therapeutical,  of  the  present  day. 

"Tlie  book  is  like  so  many  other  good  American  medical  books  which  we  have  lately 
ûad  occasion  to  notice;  it  marvellously  combines  a  résumé  of  all  the  best  European 
literature  and  practice  with  evidence  throughout  of  good  personal  judgment,  knowl- 
edge, and  experience.  It  is  gratifying  to  see  how  our  English  authors  are  quoted,  and 
especially  how  the  labors  of  Hillier,  who  died  so  prenuxiurely,  are  recognized.  But 
the  book  abounds  in  exposition  of  American  experience  and  observation  in  all  that 
relates  to  the  diseases  of  children.  Not  the  least  intere^-ting  additions  to  the  volume 
are  several  extensive  tables,  exhibiting  the  mortality  in  Philadelphia  of  some  of  the 
most  common  and  fatal  diseases  in  connection  with  the  variations  of  the  temperature, 
and  prepared  with  great  care  from  the  records  of  the  Board  of  Health. 

"The  thoroughly  fresh  nature  of  the  book  is  especially  seen  in  the  care  with  which 
certain  articles  have  been  written.  Such  are  those  on  Rickets  and  Tuberculosis,  Infan- 
tile Atrophic  Paralysis,  and  Progressive  Paralysis.  No  book  now  on  diseases  ef  chil- 
dren is  complete  which  does  not  treat  specially  of  constitutional  or  diathetic  diseases, 
such  as  rickets  and  tuberculosis,  sypliilis,  &c. 

"Among  other  articles  of  great  interest  and  value  we  would  mention  those  on  Dis- 
eases of  the  Cœcum  and  Appendix  Vermiformis,  on  Indigestion  in  Children,  on  Diar- 
rhoea, on  Entero-Colitis,  on  Intussusception,  on  Chronic  Hydrocephalus,  and  on  Croup 
and  the  value  of  Tracheotomy. 

"The  difiiculties  of  editing  a  new  edition  of  a  medical  book  of  some  standing  are 
not  more  felt  in  the  region  of  pathology  and  the  classification  of  disease  than  in  that 
of  therapeutics.  In  this  work  this  difficulty  has  been  fairly  faced  by  the  authors. 
They  have  to  confess  to  having  changed  their  practice  very  materially  in  the  treatment 
of  acute  diseases,  to  having  given. up  mercury  in  most  inflammatory  diseases,  and  ahuost 
given  up  bloodletting.  We  recommend  the  views  of  these  authors  as  to  the  injurious 
îffects  of  calomel  and  antimony  to  careful  consideration.  They  do  not  entirely  abjure 
the  use  of  bloodletting  in  certain  cases  of  pneumonia  and  meningitis.  Indeed,  we 
think  they  will  find  reason  in  future  editions  to  talk  a  little  less  freely  than  they  do 
about  bleeding  and  cupping  very  young  children  in  certain  circumstances  of  pneumonia, 
and  in  certain  cases  of  simple  meningitis.  With  a  few  exceptions  of  this  kind,  the 
therapeutics  are  sound  and  commendable,  great  importance  being  given  to  proper 
feeding  and  the  general  management  of  infancy  and  childhood.  It  is  due  to  authors 
of  so  much  fai'-ness  and  experience  to  publish  widely  their  opinion  of  the  injurious 
and  depressing  effects  of  antimony  in  the  inflammations  of  children.  To  infants  under 
two  years  of  age  they  think  it  best  to  give  no  antimony  even  in  pneumonia.  They  dp 
lot  use  tartar  emetic  at  all  in  the  cases  of  children,  but  small  doses,  such  as  the  twelf'.h 
of  a  grain,  of  the  precipitated  sulphuret  of  antimony,  every  two,  three,  or  four  hours, 
watching  its  effects,  and  withdrawing  it  quickly  if  symptoms  of  prostration  appear, 
perhaps  without  any  vomiting. 

"We  are  glad  to  add  this  work  to  our  library.  There  are  few  diseases  of  children 
which  it  does  not  treat  of  fully  and  wisely  in  the  light  of  the  latest^  physiological, 
pathological,  and  therapeutical  science."  — London  Lancet,  July  23,  1870 

I'rice,  handsomely  bound  in  Cloth    .         ...         .         .         •         .         $lj  00 

"  "  "  Leather 7  00 

LINDSAY  &  BLAKISTON,  PUBLISHERS, 

m  IL  À  DELPUIA. 


Mackenzie  on  Growths  in  the  Larynx. 

With  Numerous  Colored  and  other  Illustrations. 

TriEiR  History,  Causes,  Symptoms,  Diagnosis,  Pathology,  Prognosis, 
AND  Treatment.  Wilh  Reports  avd  Analysis  of  One  Eundred  Con- 
secKfim  Gases  treated  by  the  Author  ;  and  a  Tabular  Statement  of  evert) 
published  case  treated  since  the  invention  of  the  Laryngoscope.  By 
MoiiELL  Mackenzie,  M.D.,  Physician  to  the  Hospital  for  Diseases 
of  the  Throat,  author  of  "  The  Laryngoscope,^^  &c.    Octavo,  Price  $3.00 

"Dr.  Mackenzie  snows  possession  of  what  has  buen  well  called  '  the  complete  professional  mind.'  "  —  Tht 

Lancet. 

"  The  most  complete  and  original  essay  on  new  formations  in  the  larynx."  —  Medical  Times  and  Gazelle. 
"  A  model  of  honest  and  complete  work,  and  honorable  to  British  medicine,  as  it  is  useful  to  practitioner» 
of  every  country."  —  Brilisk  Medical  Journal. 

"This  work  will  certainly  at  once  take  its  place  as  the  author's  chief  one,  and  on  it  alone  he  may  be  content 

to  let  his  reputation  rest The  book  is  as  complete  as  it  is  possible  to  make  it."  —  Medical  Press. 

"A  storehouse  of  sound  knowledge  on  the  subject  it  treats."  —  Practitioner. 

"The  entire  profession  is  under  a  deep  obligation  to  Dr.  Mackenzie  for  his  really  interesting, instructive^ 
•Jid  opportune  essay."  —  Edinburgh  Medical  Journal. 

"  Contains  a  large  amount  of  information  which  is  of  the  very  greatest  value."  —  Glasgow  Med.  Jomiial. 

"  Of  extreme  interest  and  value,  and  reflects  the  greatest  credit  on  Dr.  Mackenzie." — Birmingham  Med.  Rev. 

"The  essay  can  hardly  fail  to  increase  Dr.  Mackenzie's  already  honorable  position  as  an  accomplished 
laryngologiet  and  instructor.  We  trust  that  the  work  will  find  readers,  not  only  among  physicians  espe- 
cially interested  in  the  subject  ol  which  it  treats,  but  among  general  practitioners  as  well.  They  will  find  it 
particularly  free  from  the  technicalities  which  often  make  works  on  special  subjects  dull  reading."  —  Amer. 
Journal  of  Medical  Science. 

"  As  a  w'ork  which  contains  much  that  is  new  and  cannot  be  found  elsewhere,  we  bespeak  for  it  a  welcome 
in  America.  It  contains  the  most  perfect  and  satisfactory  tabular  record  that  any  laryngoscopist  ha«  ever 
presented  to  the  profession."  —  JVew  York  Medical  Journal. 

"It  is  not  ia  mere  compliment  that  we  say  that  no  practitioner  engaged  in  the  surgical  treatment  of  laryn- 
geal tumors  can  afford  to  forego  the  study  of  Dr.  Mackenzie's  volume."  — New  Turk  Medical  Record. 

"This  is  certainly  the  chefd'ceurre  of  Dr.  Mackenzie's  productions The  last  and  decidedly  the  best 

section  of  the  book  is  upon  treatment.    It  is  especially  commendable  for  the  perspicuity  and  fairness  with 
which  it  discusses  the  comparative  merits  of  the  different  operations  and  instruments."  —  Phila.  Med.  Times. 

Mackenzie  on  the  Laryngoscope  in  Diseases 

Of  the  Throat,  with  an  Appendix  on  Rhinoscopy,  and  an  Essay  on 
Hoarseness,  and  Loss  of  Voice.  With  additions,  by  J.  SoLis  Cohen, 
M.D.,  Author  of  "  Lihalation,  Its  Therapeutics  and  Practice,''^  &c.  Il- 
lustrated by  two  Lithographic  Plates,  and  51  Engravings  on  Wood. 
Price $3.00 

"  The  Use  of  the  Laryngoscope  in  Diseases  of  the  Throat,  and  Essays  on  Hoarseness, 
&c.,  are  two  monographs  of  first-rate  merit.  Dr.  Mackenzie's  Essays  would  do  honor 
to  any  place  ;  and  he  has  used  tlie  opportunities  aflorded  to  diligence  and  skill  to  make 
solid  and  enduring  contributions  to  science  and  practice.  Both  works  are,  throughout, 
models  of  honest  and  complete  work,  and  are  honorable  to  medicine,  as  thej'  are  useful 
to  practitioners  of  every  country.  The  completeness  of  the  clinical  records,  the  abun- 
dant graphic  illustrations,  and  the  fulness  of  bibliographical  references,  are  excellent 
features."  —  British  Medical  Journal. 

Mackenzie's  Pharmacopoeia  of  the  Hospital 

For  Diseases  of  the  Throat,  containing  upwards  of  150  Formulée  for 
Gargles,  Throat  Collyria,  Lozenges,  Inhalations,  éc,  adapted  for 
Throat  Diseases.  Based  on.  the  British  Pharmacopoeia  o/  186T.  In 
Cloth, .         $1.25 


LINDSAY   AND   BLAKISTON  S    PUBLICATIONS. 

Meadows'  Manual  of  Midwifery,    a  New  Text-Book. 

Including  the  Signs  and  Symptom.^  of  Pregnancy,  Obstetric  Operations, 
Diseases  of  the  Puerperal  State,  éc,  &c.  By  Alfred  MEiJDOWS, 
M.D.,  llember  of  the  Royal  College  of  Physicians,  &c.,  &c.  First 
American  from  the  Second  London  Edition.  With  numerous  Illustra- 
tions.    Price, $3.00 

"Those  who  read  the  first  edition  of  this  work  will  bear  us  out  iu  thinking  that  Dr.  Moaduws's  Manual 
forms  one  of  the  most  convenient,  practical,  and  coucise  books  yet  published  on  the  subject.  It  was  e8i)e- 
cially  good  as  a  student's  manual,  and  the  author  ha.s,  iu  his  second  edition,  sought  to  make  it  of  equal  value 
to  the  practitioner.  The  part  which  treats  of  obstetric  operations  has  been  well  revised,  and  has  received 
numerous  additions,  uud  the  several  chapters  on  Unnatural  and  Complex  Labors  likewise  comprise  much 
new  matter.  Upwards  of  ninety  new  engravings  have  been  inserted  iu  this  edition,  and,  with  a  view  to 
facilitate  reference,  the  author  has  furnished  it  with  a  very  full  and  complete  table  of  conteuts  and  iudex. 
We  can  cordially  recommend  this  manual  as  accurate  and  practical,  and  as  containing  iu  a  small  compass 
a  large  amount  of  the  kind  of  information  suitable  alike  to  the  student  and  practitioner." — London  Lajicel, 
May  6,  1871. 

"  This  new  edition  of  a  book  which  was  at  once  recognized  as  a  good  manual,  is  a  considerable  improve- 
ment on  its  predecessor.  It  is  eminently  a  book  which  will  teach  the  student.  .  .  .  Not  merely  is  the  prac- 
tical treatment  of  Labor,  and  also  of  the  Diseases  and  Accidents  of  Pregnancy,  well  and  clearly  tauglit.but 
the  anatomical  machinery  of  parturition  is  more  effectively  explained  than  in  any  other  treatise  that  we 
remember;  and  besides  tliis,  the  book  is  honorably  distinguished  among  manuals  of  Midwifery  by  the  fid- 
ness  with  which  it  goes  into  the  subject  of  the  structure  and  development  of  the  ovum.  Dr.  Meadows  has 
done  good  seivice  in  giving  a  clear  account  of  this  subject  in  a  very  short  space,  yet  with  suiEcient  fulness. 
On  all  questions  of  treatment,  whether  by  medicines,  by  hygienic  regimen,  or  by  mechanical  or  operative 
appliauffis,  this  treatise  is  as  satisfactory  as  a  work  of  manual  size  could  be;  and  altogether,  students  and 
practitioners  can  hardly  do  better  than  adopt  it  as  their  vade-mecum."  —  The  Practitioner. 

Maxsoii's  Practice  of  Medicine. 

By  Edwin  R.  Maxson,  M.D.,  formerly  Lecturer  on  the  Practice  of 
Medicine  in  the  Geneva  Medical  College,  &c.  .         .         $4.00 

Morris  on  Scarlet  Fever. 

Its  Pathology  and  Therapeutics.  By  Casper  Morris,  M.D.,  Fellow  of 
the  College  of  Physicians  of  Philadelphia,  éc.     .         .         .         $1.50 

Mendenhall's  Medical  Student's  Vade  Mecum. 

A  Compendium  of  Anatomy,  Phyi^iology,  Chemistry,  the  Practice  of 
Medicine,  Surgery,  Obstetrics,  Diseases  of  the  Skin,  Materia  Medica, 
Pharmacy,  Poisons,  &c.,  &c.  By  George  Mendenhall,  M.D.,  Pro- 
fessor of  Obstetrics  in  the  Medical  College  of  Ohio,  êc,  éc.  Tenth 
Edition,  Revised  and  Enlarged,  with  224  Illustrations.         .         $2.50 

Pennsjdvania  Hospital  Reports.    Edited  by  a  con- 

mittee  of  the  Hospital  Staff,  J.  M.  DaCosta,  M.D.,  and  William 
Hunt,  M.D.      Vols.  1  and  2,  for  1868  and  1869,  each  volume  contcin. 
ing  upivards  of  Twenty   Original  Articles,  by   former  and  pjresent 
Members  of  the  Staff,  now  eminent  in  the  Profession,  with  Litho- 
graphic ar^'d  other  Illustrations.     Price  per  volume,      .         .         $4.00 
At  last,  however,  the  work  has  been  commenced,  the  Philadelphia  Physicians  being 
Ihe  first  to  occupy  this  field  of  usefulness.     The  first  Reports  were  so  favorably  re- 
ceived, on  both  sides  of  the  Atlantic,  that  it  is  hardly  necessary  to  speak  for  them  the 
universal  welcome  of  which  tliey  are  deserving.      The  papers  are  all  valuable  eontri 
butions  to  the  literature  of  medicine,  reflecting  great  credit  upon  their  authors.     The 
work  is  one  of  which  the  Pennsylvania  Hospital  may  well  be  proud.     It  will  do  much 
tcward  elevating  the  profession  of  this  country.  —  American  Journal  of  Obstetrics, 


No.  5.   The  Lymphatics  or  Absorbents. 
No.  6.   The  Digestive  Organs. 
No.  7.   The  Brain  and  Nerves. 
No.  8.  The  Organs  of  Sense  and  Voice. 
No.  9.   The  Textures.  —  Microscopic  Struc- 
tures. 


Marshall's  Physiological  Diagrams. 

LIFE-SIZE,  AND  BEAUTIFULLY  COLORED. 

On  account  of  their  large  size  and  the  great  distinctness  of  the  figures  on  them,  there 
has  been  a  growing  demand  in  this  country  for  these  Maps  for  the  Lkcture  Room  and 
fur  lecturing  from  in  Medical  as  well  as  othee  Schools.  In  order  to  supply  this 
demand  on  more  favorable  terms,  we  have  recently  completed  an  arrangement  with  the 
publishers  in  London,  by  which  we  can  sell  them  to  the  trade  and  others  at  a  reduced 
price  and  on  better  terms  than  heretofore. 

The  series,  illustrating  the  whole  Human  Body,  are  life-size,  each  map  printed  on  a 
single  sheet  of  paper,  made  specially  for  the  purpose,  1  feet  long  and  Z  feet  9  inches  broody 
colored  in  fac-similo  of  the  Original  Drawings.     There  are  nine  diagrams,  as  follows- 

No.  1.   The  Skeleton  and  Ligaments. 

No.  2.  The  Muscles  and  .Joints,  with  Ani- 
mal Mechanics. 

No.  3.  The  Viscera  in  Position.  —  The 
Structure  of  the  Lungs. 

No.  4.  The  Heart  and  principal  Blood- 
vessels. 

Prepared  under  the  direction  of  John  Marshall,  F.R.S.,  F.R.C.S.,  Pro- 
fessor of  Surgery,  University  College,  and  Surgeon  to  University  College 
Hospital. 
Price  of  the  Set,    Nine  Maps,  in  Sheets,         ....       $50.00 

"  "  "  "  handsomely  Mounted  on 

Canvas,  with  Rollers,  and  Varnished,         .....  $80.00 

Though  designed  more,  especially  for  purposes  of  general  education,  supplying  an 
ncknowledged  necessity  of  modern  teaching,  these  diagrams  will  be  found  not  inappli- 
cable to  the  requirements  of  professed  Medical  Schools,  affording,  as  they  do,  a  correct 
preliminary  view  of  the  various  s^'stems  and  organs  in  the  human  body.  For  Public 
School  Purposics,  for  Lectukes  at  Literary,  Scientific,  and  other  Institutes,  they  will 
be  found  invaluable  ;  and  also  to  students  of  Artistic  Anatomy,  imparting,  as  they  do, 
when  suspended  on  the  walls  of  the  Lecture-hall,  School-room,  or  Studio,  a  familiar 
acquaintance  witli  the  whole  human  system. 

An  Explanatory  Key  to  the  Physiological 

Diagrams.    By  John  Marshall,  F.R.S.,  F.R.C.S.,  &c.   Octavo. 
Paper  covers.       .........     50  cts. 

Description  of  the  Human  Body. 

Its   Structure    and   Functions.      Illustrated    by   Physiological  DiagraTus, 

Designed  for  the   Use  of  Teachers  in  Schools  and  Young  Men  destined 

for  the  Medical  Profession,  and  for  popidar  Instruction  generally.     New 

Edition.     By  John  Marshall,  F.K.S.,  F.R.C.S.,  Professor  of  Surgery 

University  College,  and  Surgeon  to  the  University  College  Hospital. 

Theicork  contains  260  quarto  pages  of  Text,  bound  in  cloth,  and  193  Colored 
Illustrations,  arranged  in  Nine  Polio  Diagrams,  carefully  colored  and 
reduced  from  Prof.  MarshaWs  large  work.     2  vols.     Cloth.       .     $10.00 

Murphy's  Review  of  Chemistry  for  Students. 

Adapted  to  the  Courses  as  Taught  in  the  Principal  Medical  Schools  in 
the  United  States.     By  John  G.  Murphy,  M.D.        .        .        .$1,25 


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Pereira's  Physician's  Prescription  Book. 

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in  Prescriptions,  with  Explanatory  Notes,  the  Grammatical  Comtructicua 
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to  rohich  is  added  a  Key,  containing  the  Prescriptions  in  an  unabbreviated 
Form,  with  a  Literal  Translation,  intended  for  the  use  of  Medical  and 
Pharmaceutical  Students.  By  Jonathan  Pereira,  M.D.,  F.R.S.,  etc. 
Fi'om  the  Fifteenth  London  Edition. 

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"      in  leather,  with  Tucks  and  Pocket,       .        .         .  1.50 

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country.  The  present  edition  of  which  this  is  a  reprint  has  been  carefully  revised 
and  many  additions  made  to  it.  Its  great  value  is  proven  both  by  its  large  sale  anrl 
(he  many  favorable  notices  of  it  in  the  Medical  Press. 

Paget's  Surgical  Pathology.  Third  London  Edition. 

Lectures  delivered  at  the  Royal  College  of  Surgeons  of  England,  by  James 
Paget,  F.R.S.,  Surgeon  to  St.  Bartholomew's  Hospital,  &c.,  &c.  Third 
London  Edition,  edited  and  Revised  by  William  Turner,  M.D.,  Lond. 
Prof  essor  of  Anatomy  in  the  University  of  Edinburgh,  &c.  One  volume. 
Octavo,  with  numerous  Illustrations.     Price,  ....     $Y.50 

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needs  no  introduction  to  our  readers.  Commendation  of  it  would  be  as  superfluous  as 
criticism  would  be  out  of  place.  Suffice  it  to  saj'  that  almost  evei'y  page  bears  evidence 
that  the  present  edition  has  been,  as  the  author  mentions  in  his  preface,  ".carefully  re- 
vised," from  a  clinical  point  of  view  by  himself,  and  from  the  pathological  by  his  only 
less  distinguished  editor.  Professor  Turner.  The  latest  observations  of  pathologists  in 
all  parts  of  the  world  have  received  due  attention,  and,  as  a  consequence,  the  lectures 
in  their  present  shape  are  not  only,  as  Mr.  Paget  modestly  hopes  they  may  be  oon- 
sidered,  "better  than  they  were,"  but  probably  the  very  best  to  which  the  student  of 
pathology  can  resort.  —  American  Medical  Journal. 

Prince's  Plastic  and  Orthopedic  Surgery. 

Containing, 

1.  A  Report  on  the  Condition  of,  and  Advances  made  in,  Plastic  and 

Orthoj)edic  Surgeiy  up  to  the  Year  1871. 

2.  A  New  Classification  and  Brief  Exposition  of  Plastic  Surgery. 

With  numerous  Illustrations. 

3.  Orthopedics:  A  Systematic  Work  upon  the  Prevention  and  Cure 

of  Deformities.      With  numerous  Illustrations. 

In  one  volume,  Octavo.     Price, $4.50 

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abundantly  illustrated,  and  well  printed.  It  goes  over  the  whole  ground  of  deformi- 
ties of  all  degrees  —  from  cleft-palate  and  club-foot,  to  spinal  curvatures  and  ununited 
fractures.  It  appears,  moreover,  to  be  an  original  book,  so  far  as  one  chiefly  of  com- 
pilation can  be  so.  Such  a  book  was  wanted,  and  it  deserves  success."  —  Mtd.  and 
Surg.  RepoTtfT. 


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Rindfleisch's    Text-Book     of    Pathological 

Histology.     208  Illustrations. 

An  Introduction  to  the  Stud)/  of  Palhologlcal  Aitatomy.  By  Dr.  Edward 
RiNDFLEiscii,  0.  0.  Profe^iior  of  Pathological  Analomi/  in  Bonn. 
Translated  from  the  Second  German  Edition,  by  Wm.  C  Kloman, 
M.D.,  assisted  by  F.  T.  Miles,  M.D.,  Professor  of  Anatomy,  Univer- 
sity  of  Maryland,  éc,  &c.  Containing  208  Ulaboralcly  Executed 
Microscopical  Illustrations.     Octavo.     Price,  bound  in  Cloth,     $6.00 

"  Leather,   T.OO 

For  the  fii'st  time  since  microscopical  anatomy  has  become  the  basis  of  a  true  pathol- 
ogy, American  students,  and  indeed  we  may  say  English  students,  have  access  to  a 
suitable  text-book  in  their  own  language.  Heretofore  the  opportunity  of  studying 
pathology  has  been  limited  to  a  comparative  few  who  were  familiar  with  the  German 
and  French.  But  in  the  translation  of  Rindfleisch,  we  have  furnished  us  not  merely 
an  excellent  guide,  but  actually  the  best  which  could  be  made  available,  either  to 
practitioner  or  student.  It  would  be  impossible,  and  it  is  indeed  needless,  to  present 
a  résumé  oi  its  contents.  The  volume  is  a  faithful  exposition  of  the  present  state  of 
pathological  histology;  each  subject  is  fully  and  systematically  treated,  and  may, 
therefore,  be  studied  independently  of  any  rel.ition  to  others.  The  work  of  the  trans- 
lators has  been  well  done,  and  although  a  few  idiomatic  sentences  have  crept  into  the 
text  which  are  not  vei-y  intelligible,  they  scarcely  impair  the  value  of  the  work.  No 
physician  or  student  should  be  without  it.  —  Ptdladelphia  Medical  I'imes,  Feb.  1,  1872. 

Richardson's  Practical  Treatise  on  Mechani- 
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By  Joseph  Richardson,  D.D.S.,  Pî^ofessor  of  Mechanical  Dentistry  in 
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efficient  guide.  —  BritisJi  and  Foreign  Medico- Chirurg.  Review. 

Reynolds'  Lectures  on  the  Clinical  Uses  of 

Electricit'/,  Delivered  at  the  University  College  Hospital.  By  J.  Russell 
Reynolds,  M.D.,  F.R.S.,  Professor  of  the  Princi2:)les  and  Practice 

of  Medicine,  University  College,  London,  editor  of  "A  System  of 
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could  only  feebly  convey  the  highly  practical  and  generally  useful  nature  of  the  in- 
struction it  contains.  —  Edinburgli  Medical  Journal,  January,  1872. 

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A  Practical  Treatise  on  the  Causes,  Forms,  Symptoms,  and  Besults  of 
Disease.     Second  Edition  preparing. 

Sweringen's  Pharmaceutical  Dictionary. 

A  Lexicon  of  Pharmaceutical  Science.     In  preparation. 

Schultze's  Lecture  Diagrams  for  Instruction 
in  Preii'uaiicv  and  Midwifery.    20  PMes  of  the 

largest  Imperial  size,  printed  in  colors.  iJrawn  and  Edited  with 
Explanatory  Notes  by  Dr.  B.  S.  Schultze,  Professor  of  Midwifery 
at  the  University  of  Jena.      With  -ito  volume  of  letter-press.        $15.00 

Sansom  on  Chloroform. 

Its  Action  and  Administration.  By  Arthur  Ernest  Sansom,  M.B., 
Physician  to  King^s  College  Hospital,  &c  ,  &c.     12mo.         .         $2.00 

"The  work  of  Cr.  Sansom  maybe  characterized  as  most  excellent.  Written  not 
alone  from  a  theoretical  point  of  view,  but  showing  very  considerable  experimental 
study,  and  an  intimate  clinical  acquaintance  with  the  administration  of  these  remedies, 
—  passing  concisely  over  the  whole  ground,  giving  the  latest  information  upon  every 
point,  —  it  is  just  the  work  for  the  student  and  practitioner." — Amer.  Medical  Journal. 

Scanzoni  on  Women. 

A  Practical  Treatise  on  the  Diseases  of  the  Sexual  Organs  of  Women, 
Translated  from  the  French.  By  A.  K.  Gardner,  A.M.,  M.D.,  &c. 
With  Illustrations.     Octavo,         ......         $5.00 

Stokes  on  the  Diseases  of  the  Heart 

And  the  Aorta.  By  William  Stokes,  Regius  Professor  of  Physic  in 
the  University  of  Dublin;  Author  of  the  Diseases  of  the  Chest,  &c., 
éc.     Second  American  Edition.     Octavo,    ....        $3.00 


LINDSAY   AND   BLAKISTON's   PUBLICATIONS. 

THOMAS  HAWKES  TANNER'S  WORKS. 

"The  leading  feature  of  Dr.  Tanneras  hooks  is  their  essentially  pr<irtical  character^ 

London  Lancet. 

Tanner's  Practice  of  Medicine. 

FIFTH  AMERICAN,  FROM  THE  SIXTH  LONDON  EDITION. 

Beviaed,  much  Enlarged,  and  thoroughly  brought  up  to  the  present  time. 
With  a  complete  Section  on  the  Disea.^es  Peculiar  to  Women,  an  exteu' 
sive  Appendix  of  Formulae  for  Medicines,  Baths,  &c.,  âc.  By  TnoMAa 
Hawkes  Tanner,  M.D.,  Fellow  of  the  Royal  College  of  Physicians, 
&c.     Royal  Octavo,  over  1100  pages.     Price,  bound  in  Cloth,     $6.00 

Leather,  7.00 

There  is  a  common  character  about  the  writings  of  Dr.  Tanner  —  a  character  which  constitutes  one  of  their 
chief  valufts  :  tl icy  are  all  essentially  and  thoroughly  practical.  Dr.  Tanner  never,  for  one  moment,  allows 
this  utilitarian  end  to,  escape  his  mental  view.  He  aims  at  teaching  how  to  recognize  and  how  to  cure  dis- 
ea.se,  and  in  this  he  is  thoroughly  successful.  .  .  .  It  is,  indeed,  a  wonderful  mine  of  knowledge. —  Medical 
Times. 

Tanner's  Practical  Treatise  on  the  Diseases 
of  Infancy  and  Childhood,   price,  $3.50. 

THIRD  AMERICAN  EDITION,  REVISED  AND  ENLARGED. 
By  Alfred  Meadoavs,  M.D.,  London,  M.R.C.P.,  Physician  to  the  Hos- 
pital for  Women  and  to  the  General  Lying-in  Hospital,  &c.,  &c. 

This  hook  of  Dr.  Tanner's  has  been  much  enlarged  and  the  plan  altered  by  Dr.  Meadows.  As  it  nowstanila 
it  is  probably  one  of  the  most  complete  in  our-  language.  It  no  longer  deals  with  children's  diseases  only, 
but  includes  the  peculiar  conditions  of  childhood,  both  normal  and  abnormal,  as  well  as  the  therapeutics 
epecially  applicable  to  that  class  of  patients.  The  articles  on  Skin  Diseases  have  been  revised  by  Dr.  Tilbury 
Fox,  and  those  on  Diseases  of  the  Eye  by  Dr.  Brudenell  Carter,  both  gentlemen  distinguished  in  these  spe- 
cialties.—  Medical  Times  and  Gazette. 

Tanner's  Index  of  Diseases  and  their 

Ireatnient.      WUh  upwards  0/500   Formulse  for  Medicines, 
Baths,  Mineral  Waters,  Climates  for  Livalids,  éc,  &g.    Octavo,  $3.00 

To  the  busy  practitioner  it  must  be  an  advantage  to  see  at  a  glance,  on  a  quarter  or  lialf  a  page,  the  prin- 
cipal point  in  any  disease  about  which  he  may  wish  to  have  his  memory  refreshed  or  his  mind  stimulated. 
It  will  be  found  a  most  valuable  companion  to  the  judicious  practitioner. —  The  Lancet. 

Tanner's  Memoranda  of  Poisons. 

A  New  and  much  Enlarged  Edition.     Price,        .         .         .15  cts. 

This  manual  is  intended  to  assist  the  practitioner  in  the  diagnosis  and  treatment  of  poisoning,  and  especially 
to  prevent  his  attributing  to  natural  diisease  symptoms  due  to  the  administration  of  deadly  drugs. 


Taft's  Practical  Treatise  on  Operative  Den- 
tistry.    A  NEW  EDITION,  THOROUGHLY  REVISED. 

By  Jonathan  Taft,  D.D.S.,  Professor  of  Operative  Dentistry  in  the 
Ohio  College  of  Dental  Surgery,  êc.  Second  Edition,  thoroughly  He- 
vised,  with  additions,  and  fully  brought  up  to  the  present  state  of  the 
Science.    Containing  over  100  Illustrations.    Octavo.    Leather,    $1.50 

Professor  Taft  has  done  good  service  in  thus  embodying,  in  a  separate  volume,  a  compieheusivo  view  of 
Operative  Dentistry.  This  gentleman's  position  as  a  teacher  must  have  rendered  him  familiar  with  the  most 
recent  views  which  are  entertained  in  America  on  this  matter,  while  his  extensive  e.vperience  and  well-earned 
reputation  in  practice  must  have  rendered  him  a  competent  judge  of  their  merits.  We  willingly  commenU 
Prct  Taft's  able  and  useful  work  to  the  profession.— iondo»  Denial  Review. 


LINDSAY   AND   BLAKISTON  8   PUBLICATIONS. 


Tilt's  Change  of  Life 

In  Health  and  Disease.  A  Practical  Treatise  on  the  Nervous  and 
other  Affections  incidental  to  Women  at  the  Decline  of  Life.  By 
Edwakd  John  Tilt,  M.D.     From  the  Third  London  Edition.     In 

one  volume.     Octavo, §3.00 

The  work  is  rich  iu  personal  experience  and  observation,  as  well  as  in  ready  and 
sensible  reflection  on  the  experience  and  observation  of  others.  The  book  is  one  that 
no  practitioner  should  be  without,  as  the  best  we  have  on  a  class  of  diseases  that  makes 
a  constant  demand  upon  our  care,  and  requires  very  judicious  management  on  the  part 
of  the  practitioner. — London  Lancet. 

Take.     Illustrations  of  the  Influence  of  the 
Mind  upon  the  Body.  bjOaniels.  tuke,  m.d.,  ^sso- 

ciate  Author  of  ''A  Manual  of  Psychological  Medicine,''^  &c.     Octavo. 
Price, ëô.50 

Tyler  Smith's  Obstetrics. 

A  Course  of  Lectures.  By  W.  Tyler  Smith,  M.D.,  Physician,  Ao 
coucheur,  and  Lecturer  on  Midwifery,  &c.  Edited  by  A.  K,  Gard- 
ner, M.D.     With  Illustrations.     Octavo,      ....         $5.00 

Toynbee  on  Diseases  of  the  Ear. 

Their  Nature,  Diagnosis,  and  Treatment.  A  new  London  Edition,  with 
a  S^ipj)lement.  By  James  Hinton,  Aural  Surgeon  to  Guy^s  Hospi- 
tal, &c.      With  Illustrations.     Octavo,  ....         $5.00 

Thompson's  Clinical  Lectures  on  Pulmonary 
Consumption,  octavo,  ....  $2.00 

Tyson's  Cell  Doctrine: 

Its  History  and  Present  State,  with  a  Copious  Bibliography  of  the  Sub- 
ject, for  the  use  of  Students  of  Medicine  and  Dentistry.  By  James 
Tyson,  M.D.,  Lecturer  on  Microscopy  in  the  University  of  Pennsyl- 
vania, &c.,  &c.     With  a   Colored  Plate,  and  numerous  Illustrations 

on  Wood.     Price S2.00 

Dr.  Tyson  furnishes  in  this  work  a  concise  and  instructive  resume  of  the  origin  and 
advance  of  the  doctrine  of  Cell  Evolution.  In  it  we  find  the  theories  of  Virchow,  Robin, 
Huxley,  Hughes,  Bennett,  Beale,  and  other  distinguished  men.  Its  pages  contain  what 
could  otherwise  only  be  learned  by  the  perusal  of  many  works,  and  they  supply  the 
reader  with  a  continuous,  complete,  and  general  knowledge  of  the  history,  progress, 
and  peculiar  phases  of  the  Cell  Doctriue,  accompanied  by  careful  references  and  a 
copious  bibliography. 

Virchow's  Cellular  Pathology. 

Translated  from  the  Second  Edition.  By  Frank  Chance,  B.A.,  M.A., 
&c     With  Notes  and  Emendations,  and  144  Engravings.    8vo.     $5.00 


LINDSAY    AND    BLAKISTON  S    PUBLICATIONS. 


Trousseau's  Clinical  Lectures. 

VOL.  v.,  COMPLETING  THE  WORK,  NEARLY  READY. 

Lectures  on  Clinical  Medicine,  delivered  ai  the  Hôtel-dieu,  Paris.  Bj 
A.  1'rousseau,  Professor  of  Clinical  Medicine  in  the  Faculty  of  Medi- 
cine, Paris,  &c.,  &c. 

Trousseau's  Lectures  on  Clinical  Medicine,  so  favorably  received,  as  well  hy  tlie 
profes-<ion  of  the  United  States  as  abroad,  are  published  in  this  country  in  conncctiov 
with  the  New  Sydenham  Society,  under  whose  auspices  the  translation  of  Vols.  IL  and 
in.  have  been  tnade.  Either  of  these  volumes  can  be  furnished  separately,  and  in  order 
to  still  further  extend  the  circulation  of  so  valuable  a  work,  the  Publishers  have  now 
reduced  the  price  to  Five  Dollars  per  volume. 

C'^NTENTS  OF  VoLUME  L  —  TramlaUd  and  Edited  by  P.  Victor  Bazire,  M.  D.,  êçc. — 
Lecture  1.  On  Venesection  in  Cerebral  Ilœmorrhage  and  Apoplexy.  2.  On  Apoplec- 
tiform Cerebral  Congestion,  and  its  Relations  to  Epilepsy  and  Eclampsia.  3.  On 
Epilepsy.  4.  On  Epileptiform  Neuralgia.  5.  On  Glosso-laryngeal  Paralysis.  6.  Pro- 
gressive Locomotor  Ataxy.  7.  On  Aphasia.  8.  Progressive  Muscular  Atrophy.  9. 
Facial  Paralysis,  or  Bell's  Paralysis.  10.  Cross-paralysis,  or  Alternate  Hemiplegia. 
11.  Infantile  Convulsions.  12.  Eclampsia  of  Pregnant  and  Parturient  Women.  13. 
On  Tetany.  14.  On  Chorea.  15.  Senile  Trembling  and  Paralysis  Agitans.  IG.  Ce- 
rebral Fever.  17.  On  Neuralgia.  18.  Cerebral  Rheumatism.  19.  Exophthalmic 
Goîtie,  or  Graves'  Disease.     20.  Angina  Pectoris.     21.  Asthma.     22.  Hooping  Cough. 

23.  On  Hydrophobia. 

Contents  of  Volume  II. — Translated  from  the  Edition  of  1868  [being  the  last  revised 
and  enlarged  edition),  by  John  Rose  Cormack,  M.  D.,  Edin.,  F.R.S.E.,  êfc.  —  Lecture  1. 
Small-pox.  2.  Variolous  Inoculation.  3,  Cow-pox.  4.  Chicken-pox.  5.  Scarlatina. 
6.  Measles,  and  in  particular  its  unfavorable  Symptoms  and  Complications.  7.  Rubeola. 
8.  Erythema  Nodosum.  9.  Erythema  Papulatum.  10.  Erysipelas,  and  in  particular 
Erysipelas  of  the  Face.  11.  Mumps.  12.  Urticaria.  13.  Zona,  or  Herpes  Zoster. 
14.  Sudoral  Exanthemata.  15.  Dothinenteria,  or  Typhoid  Fever.  16.  Typhus.  17. 
Membranous  Sore  Throat,  and  in  particular  Herpes  of  the  Pharynx.  18.  Gangrenous 
Sore  Throat.     19.  Inflammatory  Sore  Throat.     20.   Diphtheria.     21.   Thrush. 

Contents  of  Volume  III. — Translated  from  the  Edition  0/I868,  by  John  Hose  Cormack, 
M.D.,  Edin.,  F.R.S  E.,  ^c. — Lecture  22.   Specific  Element  in  Disease.     23.  Contagion. 

24.  OzEena.  25.  Stridulous  Laryngitis,  or  False  Croup.  26.  Œdema  of  the  Larynx. 
27.  Aphonia:  Cauterization  of  the  Larynx.  28.  Dilatation  of  the  Bronchi  and  Biou- 
chorrhœa.  29.  Hemoptysis.  30.  Pulmonary  Phthisis.  31.  Gangrene  of  tlie  Lung. 
32.  Pleurisy:  Paracentesis  of  the  Chest.  33.  Traumatic  Effusion  of  Blood  into  the 
Pleura:  Paracentesis  of  the  Chest.  34.  Hydatids  of  the  Lung.  35.  Pulmonary 
Abscesses  and  Peripneumonic  Vomicœ.  36.  Treatment  of  Pneumonia.  37.  Paracen- 
tesis of  the  Pericardium.  38.  Organic  Affections  of  the  Heart.  52.  Alcoholism.  62. 
Spermatorrhoea.  63.  Nocturnal  Incontinence  of  Urine.  64.  Glucosuria:  Saccharine 
Diabetes.     05.   Polydipsia      67.  Vertigo  a  Stomacho  L/eso. 

4  Volumes  Octavo.  Vols.  1,  2,  and  3,   Price  35.00  each  ;  Vol.  4,  Price  $4.00, 

OPINIONS  OF  THE  PRESS. 

"Trousseau  furnishes  us  with  an  example  of  the  best  kind  of  Clinical  teaching.  D  is 
a  book  iliat  deserves  to  be  popularized.  The  translation  is  perfect."  —  Medical  Timet 
and  Gazette. 

•'The  great  repuiulion  of  I'rof.  Trousseau  as  a  practitioner  and  teacher  of  Mediuius 
in  all  its  branches,  renders  the  present  appearance  of  his  Clinical  Lectures  particuliiiiy 
welcome."  —  Medical  Press  and  Circular. 

"The  publication  of  Ti-ousseau's  Lectures  will  furnish  us  with  one  cf  the  very  best 
practical  treatises  on  disease  as  seen  at  the  bedside."  —  British  and  Foreign  Med\e3- 
Chirurgical  Review. 

"A  clever  translation  of  Prof.  Trousseau's  admirable  and  exhaustive  work,  the  best 
book  of  reference  upon  ihe  Practice  of  Medicine." — Indian  Medical  Gaz'tte. 

'  The  Lectures  of  Trousseau,  in  attractiveness  of  manner  and  richness  of  thoroughly 
practical  matter,  worthily  takes  a  place  beside  the  classical  lectures  of  Watson  and 
Graves."  —  British  Medical  Journal. 

■'Trousseau  is  essentially  the  French  Graves,  and  his  lectures  should  sooner  than 
ihis  have  been  translated  into  English."  —  Lancet. 


LINDSAY    AND    BLAKTSTON'S     PUBLICATIONS. 


Wylhes'  Physician's  Pocket,  Dose,  and  Symp- 
tom Book.      THE  TENTH  EDITION. 

Containing  the  Doses  and  Uses  of  all  the  Prlncripal  Articles  of  the.  Materia 
Mcdica,  and  Original  Preparation.^  ;  A  Table  of  Weights  and  Meor 
nures.  Rules  to  Proportion  the  Doses  of  Medicines,  Common  Abbre- 
viations used  in  Writing  Prescriptions,  Table  of  Poisons  and,  Antidotes, 
Classificaiion  of  the  Materia  Medica,  Dietetic  Preparations,  Table  of 
Symptomatology,  Outlines  of  General  Pathology  and  Therapeutics,  &c. 
By  Joseph  H.  Wythes,  A.M.,  M.D.,  &c.    The   Tenth  Be  vised  Edition 

Price,  in  cloth, $1.25 

"       leather,  tucks,  with  pockets,         ....  1.50 

This  litde  manual  has  been  received  with  much  favor,  and  a  large  number  of  copies 
sold.  Tf  was  compiled  for  the  assistance  of  students,  and  to  furnish  a  vade  mecum  for 
the  general  prac'idoner,  whicli  wouM  save  the  trouble  of  reference  to  larger  and  more 
elaborate  works.  The  present  edition  has  undergone  a  careful  revision.  The  thera- 
peutical arrangement  of  the  Materia  Medica  baa  been  added  to  it,  together  with  such 
other  improvements  as  it  was  thought  might  prove  of  value  to  the  wors. 

Williams  on  Consumption,  london  edition. 

Pulmonary  Consumption  ;  Its  Nature,  Varieties,  and  Treatment.  With 
an  Analysis  of  One  Thousand  Cases  to  exemplify  its  duration.  By 
C.  J.  B.  Williams,  M.D.,  F.R.S.,  author  of  Williams'  Principles 
of  Medicine,  Senior  Consulting  Physician  to  the  Hospital  for  Con' 
sumption,  &c.  dec,  and  Charles  Theodore  Williams,  M.D.,  Physi- 
cian to  the  Hosp)ital  for  Consumption.  Brampton.  Demy  Octavo. 
Price, $3.00 

This  edition  of  Williams  on  Consumption  is  issued  in  the  United  States  by  special 
arrangement  with  the  London  publishers.  It  is  the  Author's  Edition,  printed  in  London 
under  his  supervision,  on  fine  paper  and  large  clear  type,  and  is  offered  at  a  much  less 
rate  than  under  ordinary  circumstances  it  could  be  imported  and  sold  at. 

"For  the  last  forty  years,  Dr.  Williams  has  been  studying  and  treating  Tubercular 
Diseases,  and  if  he  has  had  to  modify  much  of  his  teaching,  and  more  of  his  treatment, 
he  can  still  speak  from  a  more  enormous  experience,  and  a  closer  study  of  the  morbid 
processes  involved  in  tuberculosis,  than  most  living  men,  and  he  can  look  backwards 
and  forwards  with  as  much  satisfaction  as  most  of  his  contemporaries."  —  London 
Lancet, 

Walker  on  Intermarriage. 

Or,  the  3Iode  in  which,  and  the  Causes  lohy.  Beauty,  Health,  and  Intellect 
result  from  certain  Unions,  and  Deformity,  Disease,  and  Insanity  from 
others.  With  Illustrations.  By  Alexander  Walker,  Autnor  of 
"  Woman,^^  "  Beauty, ''  êc.  éc.     12mo.         .  .         .  $1.50 


LINDSAY   AND   BLAKTSTON's   PUBLICATIONS. 


Waring  S  Practical  Therapeutics,    a  new  edition. 

Considered  chiefly  with  reference  to  Articles  of  the  Materia  Medica. 
By  Edward  John  Waring,  F.R.C.S.,  F.L.S.,  &c.,&c.  Second  American, 
from  the  Third  London  Edition.      Royal  Octavo. 

Price  in  Cloth,  85.00;   Leather,  6.C0 

There  arc  many  features  in  Dr  "VVaving's  Therapeutics  which  render  it  especially 
valualtle  to  the  Practitioner  and  Student  of  Medicine,  much  important  and  reliable 
information  being  found  in  it  not  contained  in  similar  works;  it  also  differs  from 
them  in  its  completeness,  the  convenience  of  its  arrangement,  and  the  greater  promi- 
nence given  to  the  medicinal  application  of  the  various  articles  of  the  Materia  Medica 
in  the  treatment  of  morbid  conditions  of  the  Iluman  Body,  &c.  It  is  divided  into 
two  parts,  the  alphabetical  arrangement  being  adopted  throughout;  there  is  also  added 
an  excellent  Index  of  Diseases,  with  a  list  of  the  medicines  applicable  as  remedies, 
and  a  full  Index  of  the  medicines  and  preparations  noticed  in  the  work. 

"  This  new  eilitiun  of  Waring's  Practical  Therapeutics  has  been  altered  andimproved  with  great 
judgment.  A  satisfactory  account  of  new  agents — chloral,  «apomorphia,  nitrous  oxide,  carbolic  acid, 
kc.  Is  introduced  without  adding  to  its  bulk.  The  additions  are  made  with  remarkable  skill  in  con- 
deusatinii.    It  is  one  of  the  best  manuals  of  therapeutics  yet  in  existence." — Brit,  Med.  Journal. 

"There  has  been  no  scarcity,  latterly,  of  works  of  this  class,  several  of  them  we  regard  as  having 
great  professional  value  ;  but,  it  must  be  allowed,  we  think,  that  this  holds  no  inferior  place  among 
them.  Stillé'sis  a  national  book,  but  much  more  voiuminous;  and,  therefore,  while  it  is  high  author- 
ity, it  is  less  convenient  for  office  use.  Furthermore,  we  prefer  the  literary  arrangement  and  execu- 
tion of  Waring.  It  can  be  used  with  more  readiness  and  always  relied  on  for  the  correctness  of  its 
facts.  In  the  daily  treatment  of  diseases,  it  seems  to  supply  everything  that  can  be  desired.  The 
articles  are  arranged  ali)habetically.  and  a  paragraph  is  devoted  to  their  physical  description  and 
scientific  character.  Their  therapeutic  uses,  however,  constitute  the  bulk  of  the  volume;  and  in  this 
respect  the  labor  has  been  very  thorough." — Druggists'  Circular. 

"The  plan  of  this  work  is  admirable,  and  well  calculated  to  meet  the  wants  of  the  busy  practi- 
tioner. There  is  a  remarkable  amount  of  information,  accompanied  with  judicious  comments,  im- 
parted in  a  concise  yet  agreeable  style.  The  indications  for  the  application  of  remedies  are 
sufficiently  comprehensive,  and  their  mode  of  action  generally  accounted  for  on  rational  grounds. 
The  publishers  have  well  performed  their  part,  and  we  trust  that  their  enterprise  in  introducing  the 
work  to  the  profession  in  America  may  meet  with  that  encouragement  which  the  inherent  merits  of 
the  treatise  itself  are  entitled  to  command." — Medical  Record. 

"  Our  admiration,  not  only  for  the  immense  industry  of  the  author,  but  also  of  the  great  practical 
value  of  the  volume,  increases  with  every  reading  or  consultation  of  it.  We  wish  a  copy  could  be 
put  in  the  hands  of  every  student  or  practitioner  in  the  country.  In  our  estimation  It  is  the  beat 
book  of  the  kind  ever  written." — JV.  Y.  Medical  Journal. 

ard  on  Some  Affections  of  the  Liver 

And  Intestino.l  Canal,  with  Remarks  on  Ague  and  its  Sequelœ,  Scurvy, 
Purpura,  &c.  By  Stephen  H.  Ward,  M.D.,  F.R.C.P.,  Physician 
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\Yedrs  Dental  Pathology.     The  Patliology  of  the  Teeth. 

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lated by  W.  E.  BoARDMAN,  M.D.,  xcith  Notes  by  Tiios.  B.  Hitchcock, 
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mic Hospital,  &c.  With  169  lUmtrations.  Edited  by  S.  Litiell, 
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Watson's  Practice  abridged. 

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Wells'  Treatise  on  the  Diseases  of  the  Eye, 

illustrated   by  Ophthalmoscopic  Plates  and  Numerous  Engravings  on 
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Wri2:ht  on  Headaches. 

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of  the  Royal  College  of  Physicians,  &c.  &g.  From  the  Fourth  London 
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*'  Few  affections  are  more  unmanageable  and  more  troublesome  than  those  of  which 
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them  will  be  gladly  received  by  physicians.  The  author's  plan  is  simple  and  practical. 
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MedL'.al  and  Surgical  Reporter. 


and 


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their  Treatment  hj  the  Srientific  Use  of  Spectacles.  Third  Edition  Re 
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NEW  SYDENHAM  SOCIETY'S  PUBLICATIONS. 

VOLUMES  TO   BE  ISSUED   IN  1S72. 

I.  STRICKER'S  MANUAL  OF  HISTOLOGY.    Translated  bv  Mr.  Power. 
Vol.  II. 

II.  TROUSSEAU'S   LECTURES  ON  CLINICAL  MEDICINE.    Fifth  au<j 
concluding  Volume,  with  Index. 

III.  RINDFLEISCH'S  MANUAL  OF  PATHOLOGICAL  HISTOLOGY. 

IV.  A  TWELFTH  FASCICULUS  OF  THE  ATLAS  OF  LIFE-SIZE  POR- 

TRAITS OF  SKIN-DISEASES. 

LINDSAY  cij  BLAKISTOX,  Philadelphia, 

AGENTS   IN   THE   UNITED   STATES. 


WORKS  ALREADY  PUBLISHED. 


1859.     {First  Year.) 
Vol.    1.  DlD\Y  on  Infantile  Sypliilis. 

2.  Ooocn  on  Disc:ises  of  Women. 

3.  Memoirs  on  Oiiilitberia. 

4.  Van  der  Kolk  on  the  Spinal  Cord,  &c. 

(.  Monographs   (Kussnial   &   Tenner,  Qr»fe, 
Wagner,  Ac.) 

1860.  (Second  Year.) 

Vol.    6.  Dr.  BmoHT  on  Abdominal  Tumors. 

7.  Frerichs  on  Diseases  of  the  Liver.     Vol.  I. 

8.  A  Yearbook  for  1859. 

9.  Atlas  of  Portraits  cf  Skin  Diseases.     (1st 

Fasciculus.) 

1861.  (TJiird  Tear.) 
Tot.  10.  A  Yearbook  for  1860. 

11.  MoNOORAPiis  {Czerniak,  Duscli,  Radicke,  Ac.) 

12.  Casper's  Foreitsic  Medicine.     Vol.  I. 

14.  Atlas  of  Portraits  of  Skin  Diseases.     (2nd 

Fasciculus.) 

1862.    (Fnurt/i  Tear.) 
Vol.  13.  Frerichs  on  Diseases  of  the  Liver.    Vol.  II. 

15.  A  Yearbook  for  1861. 

16.  Casper's  Forensic  Medicine.    Vol.  11. 

17.  Atlas  of  Portraits  of  Skin  Diseases.     (3d 

Fivsciculus.) 

1863.  (Fifth  Tear.) 
Vol»  18.  Kramer  on  Di.seases  of  the  Ear. 

19.  A  Yearbook  for  1S62. 

20.  NEOBAnER  and  VoQEL  CD  the  Urine. 

1864.  (Sixth  rear.) 

Vol.  21.  Casper's  Forensic  Medicine.     Vol.  III. 

22.  Donders  on  the  Accommodation  and  Refrac- 

tion of  the  Eye. 

23.  A  Yearbook  for  1863. 

24.  Atlas  of  Portraits  «f  Skin  Diseases.    (4th 

Fasciculus.) 

1870.     {Twelfth  Year.) 
Trousseau's  Clinical  Medicine.     Vol.  III. 
Strieker's  Manual  of  Histology.     Vol.  I. 
Niemeyer's  Lectures  on  Phthisis. 
K  Tenth  Fasciculus  of  the  Atlas  of  Skin  Dis- 
eases. 


18G&.     (Srventh  Tear.) 
Vol.  25.  A  Yearb'iok  for  18t>4. 

26.  Casper's  Korensic  Medicine.     Vol.  IV. 

27.  Atlas  of  P.jrtraits  of  Skin  Disease*.    (5th 

Fasciculus.) 

1866.  (Eighth  rear.)  ^ 

Vol.  28.  BerxutzAGoupil  on  the  Diseases  of  Women 

29.  Atlas  of  Portraits  of  Skin  Disease».    (6tb 

Fasciculus.) 

30.  IIebra  on  Diseases  of  the  Skin.     Vol.  I. 

31.  Beknutz  &  GuUPlL  on  Diseases  of  Women. 

Vol.  II. 

1867.  (Ninth  Year.) 

Vol.  32.  A  Biennial  Retrospect  of  Medicine  and  Sur- 
gery. 

33.  Oriesinoer  on  Mental  Pathol  jgy  and  Thera- 

peutics. 

34.  Aths  ijf  Portraits  of  Skin  DL-efisei,     (Jth 

Fasciculus.) 
3.5.  Trousseau's  Clinical  Medicine.    Vol.  I. 

1868.  (Tenth  Year.) 

Vol.  36.  The  Collected  Wor^s  of  Dr.  Addison. 

37.  IlEluiA  on  Skinl)  iseases.     Vol.  II. 

38.  Lanceueaux's  Treatise  on  Syphilis.     Vol.  I. 

39.  Atlas  of   Portraits  of  Sklu  Diseases;   (8th 

Fasciculus.) 

40.  A  Catalogue  of  the  Pouiraits  issued  in  th6 

Society's  Atlas  of  Skin  Disea.-es.  (Parti.) 

1869.     (Eleventh  Year.) 
Vol.  41.  Trousseau's  Clinical  Medicine.    Tran.slated 
and  edited  liy  Dr.  Rnpe  Cormack.  Vol.  It 

42.  Biennial  Retrospkot  of  Medicine  and  Sur- 

GERy,  for  1867-8.  Edited  hy  Dr.  Anstie 
Dr.  Barnes.  Mr.  Holmes,  Mr.  Power,  Mr 
Carter,  and  iJr.  Underwiod. 

43.  Lanckreaux  on  Syphilis.    Translated  by  Dr 

Whitley.     Vol.  II..  completing  the  \Vi,r/c 

44.  A  Ninth  Fasciculus  of  the  Atlas  of  Pob 

traits  of  SKI.N  DlSEAiiS 

1871.     (Thirteenth  Year.) 
Wunderlich  on  Temperature  in  Disease. 
Trousseau's  Clinical  Medicine.     Vol.  iV, 
A  Biennial  Retrospect  of  Medicine  and  Sur- 
gery for  1869-70. 
Fasciculus  of  Skin  Diseases. 


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o  o  3sr  T  E  n^  T  s. 


1.  Table  of  Signis,  i,r  vînide  for  Registering  Viaits,  Mn- 

g:\ge nil' tits,  ifcc. 

2.  An  Alni;iimc 

5.  Marshall  Hall's  Rpady  Method  iu  Asphyxia, 
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.4ITKEX-S  Science  and  Practice  of  Me«lieine.    The  Third  American  Edition,  with  Additiont 
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SA?fI>ERSOX  &  FOSTER'S  HauflbooU  for  the  Eaboratory.     Being  Practical  Exorciiei 

for  Students  in  Physiology  and  Histology.     Preparing. 
CAZEAi:X"S  Text-Book  of  Obstetrics.  — Fifth  American  Edition.    Illustrated. 
WARIXG'S  Practical  Therapeutics.  — From  the  Third  London  Edition. 
RIXDFEEISCH'S  Text-Book  of  Pathological  Histology. —Containing  208  Elaborately 

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MEIGS  &  PEPPER'S  Practical  Treatise  on  theDiscasesof  Children.— Fourth  Bd, 
TANNER  «fc  MEADOWS  Diseases  of  Infancy  and  Childhood.— Thud  American  Ed- 
BIDDEE'S  Materia  Medica,  for  Students.     Fourth  Edition.    With  Illustrations. 
«ANT'S  Science  and  Practice  of  Snrgrery — iro  Illustrations. 
HARRIS'S  Principles  asid  Practice  of  Dentistry — The  Teuth  Revised  Edition 
PAGET'S  Surgical  Pattiology.— By  Turner.    Third  London  Edition 
SOELBERG  TVEEES  on  Diseases  of  the  Eye.— Second  London  Edition. 
BTFORD'S  Practice  of  Medicine  and  Surgery,  applied  to  the    Diseases  of 

Wonien.— Second  Edition.    Illustrated. 

HEWITT'S  Diagnosis  and  Treatment  of  the  Diseases  of  Wonjen.-Third  Edition. 

HEADLAND  on  the  Action  of  Medicines — sixth  American  Editiou. 
BEAEE'S  lEow  to  Work  wiîh  the  Microscope. —  Fourth  Edition. 
HABEEir  on  the  Urine  and  its  Deranirenieiits.    With  Illustrations. 

MANUALS    FOR   STUDENTS. 

MEADOW'S  MannaJ  of  Mi<8wifery.— Second  Edition  Illnstrated. 

ATTHII.iE'S  Manual  of  the  Diseases  of  Women.— With  Illustrationa. 

tAWSON'S  Diseases  and  Injuries  of  the  Eye,  their  Medical  and  Surgical  Treatrnent, 

CHEW'S  Eectures  on  Medical  Education. 

MENDE:?ÇHAEE'S  MedScal  Student's  Vade  Mecnm.— The  Tenth  Edition.    224  lUustrationa. 

ROBERTSON'S  Manual  for  Extraetiang  Teeth.— Second  Edition.    Revised. 

DIXON'S  Practical  Study  of  the  Diseases  of  the  Eye.— Third  Edition. 

PEREIRA'S  Physician's  Prescription  Book.— The  Fifteenth  Revised  Edition. 

REESE'S  Analysis  of  Physiology.— Second  Edition. 

WYTHES'  Pocket  Dose  and  Symptom  Book.— Tenth  Edition,  with  Additions. 

BARTH  &  ROGER'S  Manual  of  Auscultation  and  Percnssion.-eixth  Edition. 

CLEAVEEAND'S  Pronouncing  Medical   Eexicon.— Thirteenth  Edition. 

Eâ^GG'S  Guide  to  the  Examination  of  the  Urine.— Third  London  Edition. 

ÏÎIEE's    Pocket   Anatomist,  for  the  use  of  Students. 

TANNER'S  Memoranda  of  Poisons.  —  From  the  Third  London  Edition. 

RIGBIT'S  Obstetric  Memoranda.    Fourth  EdiUou. 

yf  complete  Descriptive  Catalogue  of  their  Publications^  together 
with  a  classified  and  priced  list  of  all  recent  Medical  Books^  American 
and  English^  furnished  or  mailed  free  on  application. 


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